Marital status and survival in patients with cancer

A Systematic Review: The Effect of Cancer on the Divorce Rate

Introduction

Research on the impact of cancer on close relationships brings up conflicting results. This systematic review collects empirical evidence on the research questions whether a cancer diagnosis in general or the type of cancer affects the divorce rate.

Materials and Methods

This systematic review was conducted according to the guidelines of the Cochrane Collaboration and the PRISMA statement. The following electronic databases were searched: Web of Science, Ovid SP MEDLINE, PsycINFO, PsyINDEX, CINAHL, ERIC. Risk of bias assessment was performed with the preliminary risk of bias for exposures tool template (ROBINS-E tool). The grading of methodological quality was assessed with the Newcastle-Ottawa Scale.

Results

Of 13,929 identified records, 15 were included in the qualitative synthesis. In 263,616 cancer patients and 3.4 million healthy individuals, we found that cancer is associated with a slightly decreased divorce rate, except for cervical cancer, which seems to be associated with an increased divorce rate.

Discussion

According to this systematic review, cancer is associated with a tendency to a slightly decreased divorce rate. However, most of the included studies have methodologic weaknesses and an increased risk of bias. Further studies are needed.

Predictive and Prognostic Assessment Models for Tumor Deposit in Colorectal Cancer Patients With No Distant Metastasis

Background

More and more evidence indicated that tumor deposit (TD) was significantly associated with local recurrence, distant metastasis (DM), and poor prognosis for patients with colorectal cancer (CRC). This study aims to explore the main clinical risk factors for the presence of TD in CRC patients with no DM (CRC-NDM) and the prognostic factors for TD-positive patients after surgery.

Methods

The data of patients with CRC-NDM between 2010 and 2017 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. A logistic regression model was used to identify risk factors for TD presence. Fine and Gray’s competing-risk model was performed to analyze prognostic factors for TD-positive CRC-NDM patients. A predictive nomogram was constructed using the multivariate logistic regression model. The concordance index (C-index), the area under the receiver operating characteristic (ROC) curve (AUC), and the calibration were used to evaluate the predictive nomogram. Also, a prognostic nomogram was built based on multivariate competing-risk regression. C-index, the calibration, and decision-curve analysis (DCA) were performed to validate the prognostic model.

Results

The predictive nomogram to predict the presence of TD had a C-index of 0.785 and AUC of 0.787 and 0.782 in the training and validation sets, respectively. From the competing-risk analysis, chemotherapy (subdistribution hazard ratio (SHR) = 0.542, p < 0.001) can significantly reduce CRC-specific death (CCSD). The prognostic nomogram for the outcome prediction in postoperative CRC-NDM patients with TD had a C-index of 0.727. The 5-year survival of CCSD was 17.16%, 36.20%, and 63.19% in low-, medium-, and high-risk subgroups, respectively (Gray’s test, p < 0.001).

Conclusions

We constructed an easily predictive nomogram in identifying the high-risk TD-positive CRC-NDM patients. Besides, a prognostic nomogram was built to help clinicians identify poor-outcome individuals in postoperative CRC-NDM patients with TD. For the high-risk or medium-risk subgroup, additional chemotherapy may be more advantageous for the TD-positive patients rather than radiotherapy.

A comparison of clinicopathologic features of prostate cancer between Nigerian and South African black men

Background

Globally, prostate cancer (PCa) is the commonest non-cutaneous male malignancy. It is more aggressive among black men with little known reasons as to the cause and continued trend among black men. This disproportionate pattern of PCa especially among black men of African ancestry resident in Africa calls for a closer look. Nigeria and South Africa, combined, have the highest cumulative risk incidence of PCa in Africa. The present study investigated the clinicopathologic behaviour of PCa among Nigerian and South African black men and the relationship between the disease and socio-demographic characteristics alongside medical co-morbidities.

Methods

A retrospective cross-sectional study was undertaken in which de-identified records of 234 black men with pathologically confirmed PCa between 2007 and 2017 from two tertiary hospitals, in Nigeria (National Hospital, Abuja) and South Africa (Tygerberg Hospital, Cape Town), were reviewed.

Results

Median age at presentation from both countries was 66 years (interquartile range, IQR 61–73 years) while the median PSA at presentation was 46 ng/ml (IQR 16–336.5 ng/ml). Half of the men (117/234) presented with locally advanced disease while metastatic disease was observed in 65.9% (27/41) of Nigerian men and 34.1% (14/41) of South African men. Thirty-three per cent of the men presented with organ-confined disease. Overall, Nigerian men presented with less organ-confined disease and significantly higher stage of disease (p < 0.001). Risk stratification using PSA, Gleason scores and T-staging showed that 84.2% (n = 197) of all the men presented with high-risk PCa disease. There was a statistically significant difference between Nigerian and South African black men (p = 0.003) in terms of disease risk at presentation. Logistic regression analysis showed that age (Adjusted OR 1.053 (95% CI 1.003–1.106), p = 0.003) and country of residence (Adjusted OR 4.281 (95% CI 1.690–10.844), p = 0.002) had a statistically significant relationship with high risk of PCa while disease co-morbidities (like diabetes and hypertension) and rural/urban location in both countries did not.

Conclusions

Disparities exist between PCa presentation and clinicopathologic behaviour among Nigerian and South African black men. Nigerian men showed higher disease risk at presentation. Environmental-genetic interactions need further exploration in the aetio-pathogenesis of PCa in black men of African ancestry.

Large household reduces dementia mortality: A cross-sectional data analysis of 183 populations

BACKGROUND

Large households/families may create more happiness and offer more comprehensive healthcare among the members. We correlated household size to dementia mortality rate at population level for analysing its protecting role against dementia mortality.

METHODS

This is a retrospective cross-sectional study. Dementia specific mortality rates of the 183 member states of World Health Organization were calculated and matched with the respective country data on household size, Gross Domestic Product (GDP), urban population and ageing. Scatter plots were produced to explore and visualize the correlations between household size and dementia mortality rates. Pearson's and nonparametric correlations were used to evaluate the strength and direction of the associations between household size and all other variables. Partial correlation of Pearson's approach was used to identify that household size protects against dementia regardless of the competing effects from ageing, GDP and urbanization. Multiple regression was used to identify significant predictors of dementia mortality.

RESULTS

Household size was in a negative and moderately strong correlation (r = -0.6034, p < 0.001) with dementia mortality. This relationship was confirmed in both Pearson r (r = - 0.524, p<0.001) and nonparametric (rho  =  -0.579, p < 0.001) analyses. When we controlled for the contribution of ageing, socio-economic status and urban lifestyle in partial correlation analysis, large household was still in inverse and significant correlation to dementia mortality (r = -0.331, p <0.001). This suggested that, statistically, large household protect against dementia mortality regardless of the contributing effects of ageing, socio-economic status and urban lifestyle. Stepwise multiple regression analysis selected large household as the variable having the greatest contribution to dementia mortality with R2 = 0.263 while ageing was placed second increasing R2 to 0.259. GDP and urbanization were removed as having no statistically significant influence on dementia mortality.

CONCLUSIONS

While acknowledging ageing, urban lifestyle and greater GDP associated with dementia mortality, this study suggested that, at population level, household size was another risk factor for dementia mortality. As part of dementia prevention, healthcare practitioners should encourage people to increase their positive interactions with persons from their neighbourhood or other fields where large household/family size is hard to achieve.

How socioeconomic and clinical factors impact prostate-cancer-specific and other-cause mortality in prostate cancer stratified by clinical stage: Competing-risk analysis

BACKGROUND

The aim of this study was to analyze the causes of death and risk factors of prostate-cancer-specific mortality (PCSM) and other-cause mortality (OCM) at different clinical stages using data from the Surveillance, Epidemiology, and End Results database.

METHODS

The characteristics and cause-specific death classifications of males with prostate cancer (PCa) were extracted. Multivariate competing-risk regression analysis was used to identify significant predictors and quantify the cumulative incidence of PCSM and OCM at different clinical stages.

RESULTS

Of the 244,433 PCa patients who were included, 19,274 died from 7356 PCSM, and 11,918 from OCM. The proportion of PCSM gradually increased from 2010 to 2016. The risk factors for PCSM in the localized PCa stage included older age, not being married, living in a county with higher poverty rates, and higher PSA levels and Gleason scores. Meanwhile, Medicaid and lower education levels were the additional risk factors of OCM. The risk factors for PCSM in the regional PCa stage included older age, not being married, Medicaid, living in a county with higher poverty rates, and higher PSA levels and Gleason scores. Meanwhile, the income level did not affect OCM risk. The risk factors for PCSM in the distant metastatic PCa stage included a separated/divorced/widowed marital status, Medicaid, and higher PSA levels and Gleason scores. Meanwhile, older age, an unmarried or separated/divorced/widowed marital status, and higher PSA levels were risk factors for OCM. In addition, receiving both surgery and radiation was worse than just receiving surgery for PCa specific survival in localized and regional PCa patients.

CONCLUSION

Some pretreatment and treatment factors may influence OCM that are not identical to those for PCSM at the corresponding stage. Decision-makers and managers should fully consider OCM to maximize treatment benefits for PCa.

Characteristics and Predictors of Long-Time Survivors in Non-Metastatic Gastric Signet Ring Cell Carcinoma: A Large Population-Based Study

Objective

Gastric signet ring cell carcinoma (SRCC) is a distinct entity with a relatively poor prognosis. This study analyzed the clinicopathological characteristics of long-time survivors (LTSs) and identified independent predictors of long-term survival (LTS) in non-metastatic gastric SRCC.

Methods

Data from 3906 patients with non-metastatic gastric SRCC were retrieved from Surveillance, Epidemiology and End Results according to the inclusion and exclusion criteria. Patients were randomly divided into training and validation cohorts. Predictors of LTS in the training cohort were identified by multivariate logistic regression. A nomogram-based predictive model for LTS was constructed in non-metastatic gastric SRCC.

Results

There were 800 patients who survived for >5 years and were defined as TLSs. Young age, other race (not black or white population), female gender, married status, small tumor size, low tumor infiltration, and negative lymph node involvement were independent predictors of LTS in non-metastatic gastric SRCC. These seven variables were incorporated into a nomogram model for predicting LTS. The calibration curve showed good consistency between observed and predicted probability of LTS, and the receiver operating characteristic curve showed acceptable discriminative capacity in the training and validation cohorts.

Conclusion

This study provides an overview of the features of patients with non-metastatic gastric SRCC. Age, race, sex, marital status, tumor size, tumor infiltration, and lymph node involvement were identified as independent predictors of LTS.

Assess and Evaluation the Quality Of Life (Qol) Among Cancer Patients Undergoing Treatment by Using EORTC QLQ-30 Scale

Background: Cancer is a challenge for majority of population’s health-related quality of life (HRQoL), compromising their physical health and emotional well-being. QoL is equally distributed among different social groups. The aim of this study to analyze the impact of clinical characteristics and social determinants of health on the QoL of a cohort of persons diagnosed and/or treated for cancer. Methods: We performed a cross-sectional study in a cohort of 155 with various stages of cancer at different stages of their disease. Data were obtained using questionnaires QLQ-C30 from the European Organization for Research and Treatment of Cancer (EORTC), which include a set of functional and symptomatic scales. We conducted descriptive and bivariate analysis using the Chi-Square test, Anova Test and adjusted for relevant variables using logistic regression. The dependent variables were the functional scales of QoL and the independent variables were socio-demographic and clinical variables. Results: Among the participants, 80(51.6%) were male and 75(48.4%) were female and majority 66(42.6%) in between the age of 40-60 years. Large proportion of patients were diagnosed with Oral cancer 67(43.2%), and Breast cancer 23(14.8%), and the clinical stages during the beginning of therapy were maximum at stage II a 104(67.1%). The mean of global health status/QoL was 52.34 (SD= 23.34). Quality of life was found to be significantly associated with some functional scales as role functioning (P≤0.001), social function, (P=0.00), and symptom scales as pain (P=0.00), loss of appetite (P=0.004) and financial impact (P=0.02) as well as associations were noted in relation to socio demographic characteristics. Women from the most disadvantaged class, and showed the poorest results for most of the function scales. In contrast, age, education, occupation and social status had differential effects depending on the function studied. The highest functional status was cognitive functioning (54.58±27.68). Conclusions: The cancer diagnosis has become more prevalent and carries significant changes to the method of living with physical and emotional changes in term of quality of life (QoL) because of inconvenience, torment, disfigurement, reliance and loss of confidence. In addition, addressing the unmet needs of these patients and ensuring higher satisfaction rate are recommended to maintain adequate HRQoL.

[Partnership and family aspects of cancer]

Cancer is not only a challenge for the patient, but can also be associated with psychosocial distress for relatives, especially partners and minor children. Although studies on the long-term effects of cancer on partners, the partnership, and child development are still rare, there are indications that the psychological distress on relatives may become chronic, and that parental illness is a risk factor for a child to develop mental disorders. In addition, a deterioration in partnership satisfaction also increases the risk of separation.Psycho-oncology care should therefore not only consider the patient's psychosocial burden but also that of the partner, as well as its effect on the partnership. Appropriate offers, for example to increase partnership and sexual satisfaction, communication, or dyadic coping, should be made. Children should also be treated as relatives in care. Focusing on both the child's distress and on improving the parent-child relationships and parenting behavior can help children to cope with parental illness in the long term. Thus, cancer should be viewed on the individual, dyadic, and family level, and psychosocial care services should be provided at all levels.

The Impact of Socioeconomic Status on Staging, Prognosis in Hepatocellular Carcinoma

Purpose

We conducted this large population-based study to evaluate the impact of socioeconomic status (SES) factors on cancer-specific survival (CSS) of patients with hepatocellular carcinoma (HCC). We further assessed the value of a novel TNM-SES staging system, which incorporated these SES factors with TNM stage on staging and prognosis.

Methods

A total of 13,791 patients diagnosed with HCC from 2012 to 2016 were retrieved from one large population database. Cox proportional hazards regression model and Harrell’s concordance index (C-index) were used to identify the SES factors associated with CSS and analyze the prognostic value of TNM-SES stage. Kaplan–Meier curves and Log rank test were performed to evaluate CSS.

Results

Four SES factors (marital status, insurance status, education, household income) were identified as the prognostic factors associated with CSS. The SES-2 (lower SES) stage was significantly correlated to unfavorable CSS of the patients with HCC, with a 32.0% increased risk (HR = 1.32, 95% CI (1.26–1.39), P < 0.001), after adjusting for several confounders. The C-index of the TNM-SES stage was 0.735 (95% CI (0.729–0.741)) which was higher than that of the TNM stage (0.718, 95% CI (0.712–0.724)), indicating a high accuracy of prognostic prediction.

Conclusion

Our comprehensive study revealed that SES was significantly associated with prognosis of patients with HCC after adjusting several confounders. The novel TNM-SES staging system which combined TNM stage and SES stage had more superior predictive value than the traditional TNM stage. Disparity on SES should receive more attention for patients with HCC in clinical management.

Impact of marital status on survival in patients with stage 1A NSCLC

OBJECTIVES

To study how marital status influences overall survival (OS) in patients with stage IA non-small cell lung cancer (NSCLC). And whether the result is valid in different time periods.

MATERIALS AND METHODS

We retrospectively analyzed 55,207 cases of stage IA NSCLC from 1995 to 2015 in the Surveillance, Epidemiology, and End Results (SEER) database. Marital status was classified as follows: married or with unmarried/domestic partner (MR/W.P), divorced or separated (DV/SP), widowed (WD), and single (never married). Patients diagnosed in 1995-2005 and 2006-2015 were analyzed separately as groups 1 and 2, respectively, to validate the results. Within each group, age-stratified demographic, clinicopathologic features, and OS were compared among different marital statuses.

RESULTS AND CONCLUSIONS

A total of 55,207 cases were included (group 1 n=20,223, group 2 n=34,984). From 1995-2005 to 2006-2015, median OS was prolonged significantly in all patients besides the DV/SP subgroup. In general, being MR/W.P was associated with the lowest relative risk of death in the study population (Group 1, HR= 0.854, 95%CI: 0.816-0.893; Group 2, HR = 0.799, 95%CI: 0.758-0.842). Meanwhile, OS of DV/SP and widowed patients was similar. In group 2, being single was associated with lower risk of death beyond 60-year-old.

Clinical and Demographic Predictors of Health-Related Quality of Life After Orthopedic Surgery With Implant Placement

Background: Orthopedic surgeries can rehabilitate injuries and at the same time improve the patients’ quality of life. The study aimed to assess patients’ health-related quality of life (HRQOL) six months after an orthopedic surgery with implant placement.

Materials and methods: A cross-sectional study with the use of a structured questionnaire among 103 patients was conducted. The 36-Item Short Form Survey (SF-36) questionnaire was used to evaluate patients’ quality of life.

Results:According to the findings of the multivariate linear regression analysis, low age, marital status (married in comparison to unmarried/ divorcees/widows), reduced intensity of the pain, and low educational attainment were associated with a better quality of life. Furthermore, the patients who were living with another person and the patients who underwent surgery on a part of the body other than the hip presented better quality of life. The results of the multivariate analysis explained 33%-67% of the variance of the SF-36 HRQOL.

Conclusion: Measuring quality of life is a valuable asset that helps to reveal the frail patient groups, in which health professionals will prioritize their care and the state in turn will design primary care services to meet their needs after discharge from the hospital.

Development and External Validation of a Nomogram to Predict Cancer-Specific Survival in Patients with Primary Intestinal Non-Hodgkin Lymphomas

Purpose

Primary intestinal non-Hodgkin lymphoma (PINHL) is a biologically and clinically heterogeneous disease. Few individual prediction models are available to establish prognoses for PINHL patients. Herein, a novel nomogram was developed and verified to predict long-term cancer-specific survival (CSS) rates in PINHL patients, and a convenient online risk calculator was created using the nomogram.

Materials and Methods

Data on PINHL patients from January 1, 2004, to December 31, 2015, obtained from the Surveillance, Epidemiology, and End Results (SEER) database (n = 2372; training cohort), were analyzed by Cox regression to identify independent prognostic parameters for CSS. The nomogram was internally and externally validated in a SEER cohort (n = 1014) and a First Affiliated Hospital of Guangzhou University of Chinese Medicine (FAHGUCM) cohort (n = 37), respectively. Area under the receiver operating characteristic curve (AUC), calibration curves, and decision curve analysis (DCA) were used to evaluate nomogram performance.

Results

Five independent predictors were identified, namely, age, marital status, Ann Arbor Stage, B symptoms, and histologic type. The nomogram showed good performance in discrimination and calibration, with C-indices of 0.772 (95% CI: 0.754–0.790), 0.763 (95% CI: 0.734–0.792), and 0.851 (95% CI: 0.755–0.947) in the training, internal validation, and external validation cohorts, respectively. The calibration curve indicated that the nomogram was accurate, and DCA showed that the nomogram had a high clinical application value. AUC values indicated that the prediction accuracy of the nomogram was higher than that of Ann Arbor Stage (training cohort: 0.804 vs 0.630; internal validation cohort: 0.800 vs 0.637; external validation cohort: 0.811 vs 0.598), and Kaplan–Meier curves indicated the same.

Conclusion

A nomogram was developed to assist clinicians in predicting the survival of PINHL patients and in making optimal treatment decisions. An online calculator based on the nomogram was made available at https://cuifenzhang.shinyapps.io/DynNomapp/.

Relationship between marital status and survival in patients with lung adenocarcinoma: A SEER-based study

Numerous studies have focused on whether the marital status has an impact on the prognosis in patients with non-small cell lung cancer, but none have focused on lung adenocarcinoma.We selected 61,928 eligible cases with lung adenocarcinoma from the Surveillance, Epidemiology, and End Results database from 2004 to 2016 and analyzed the impact of marital status on cancer-specific survival (CSS) using Kaplan-Meier and Cox regression analyses.We confirmed that sex, age, race, cancer TNM stage and grade, therapeutic schedule, household income, and marital status were independent prognostic factors for lung adenocarcinoma CSS. Multivariate Cox regression showed that widowed patients had worse CSS (hazard ratio 1.26, 95% confidence interval 1.20-1.31, P < .001) compared with married patients. Subgroup analysis showed consistent results regardless of sex, age, cancer grade, and TNM stage. However, the trend was not significant for patients with grade IV cancer.These results suggest that marital status is first identified as an independent prognostic factor for CSS in patients with lung adenocarcinoma, with a clear association between widowhood and a high risk of cancer-specific mortality. Psychological and social support are thus important for patients with lung adenocarcinoma, especially unmarried patients.

Development and Validation of Prognostic Survival Nomograms for Patients with Anal Canal Cancer: A SEER-Based Study

Objective

Anal canal cancer is a rare malignancy with increasing incidence in recent times. This study aimed to develop two nomograms to predict the overall survival (OS) and cancer-specific survival (CSS) of patients with anal canal cancer.

Methods

Information of patients with anal canal cancer from 2004 to 2015 was extracted from the surveillance, epidemiology, and end results (SEER) database. Cox analysis was used to select the risk factors for prognosis, and nomograms were constructed using the R software. The C-index, area under the curve (AUC) of time-dependent receiver operating characteristic (ROC) curves, calibration plot and decision curve analysis (DCA) were used to assess the clinical utility of the nomograms.

Results

A total of 2458 patients with malignant tumours of the anal canal were screened out. Sex, age, marital status, histological type, grade, tumour size, AJCC stage, SEER stage and chemotherapy were independent prognostic factors for OS, whereas sex, age, race, histological type, grade, tumour size, AJCC stage, SEER stage and radiotherapy were independent prognostic factors for CSS. In the training cohort, the C-index value for OS nomogram was 0.73 (95% CI, 0.69-0.77), and the AUC values that predicted the 1-, 3- and 5-year survival rates were 0.764, 0.758 and 0.760, respectively, whereas the C-index value for CSS nomogram model was 0.74 (95% CI, 0.69-0.79), and the AUC values were 0.763, 0.769 and 0.763, respectively. The calibration plot and DCA curves demonstrated good prediction performance of the model in both the training and validation cohorts.

Conclusion

The established nomogram is a visualisation tool that can effectively predict the OS and CSS of patients with anal canal cancer.

Racial and Socioeconomic Disparities in MRI-Fusion Biopsy Utilization to Assess for Prostate Cancer

OBJECTIVE

To evaluate whether racial disparities in MRI-Bx usage persisted after correction for socioeconomic, demographic, and clinical factors.

METHODS

This is a retrospective cohort study of patients who received either MRI-Bx or systematic biopsy (SB) within a single academic medical center between January 2018 - June 2020. For each patient, socioeconomic variables including household income, education, percent below poverty, and unemployment were estimated using 2015 American Community Survey census-tract level data. Chi-square analysis was used to examine differences in clinical and demographic characteristics between the two groups. The Benjamini-Hochberg procedure was used to control false discovery rate (FDR) for multiple testing.

RESULTS

Eighteen percent of Black men (53/295) received MRI-Bx while 41% (228/561) of white men received MRI-Bx. Patients coming from highly impoverished areas were less likely to receive MRI-Bx, 25% versus 75%, respectively. In multivariate analysis, race remained significantly different across MRI-Bx and SB groups. Clinical factors including family history, DRE, BMI, and prostate volume were not significantly different between patients receiving MRI-Bx and SB.

CONCLUSIONS

Black men are less likely to receive MRI-Bx than white men, even after adjusting for clinical and socioeconomic characteristics. Further work is necessary to identify and study methods to increase equity in PCa diagnostic testing.

Health-Related and Behavioral Factors Associated With Lung Cancer Stage at Diagnosis: Observations From Alberta's Tomorrow Project

Background

Lung cancer is the leading cause of cancer death in Canada, with stage at diagnosis among the top predictors of lung cancer survival. Identifying factors associated with stage at diagnosis can help reduce lung cancer morbidity and mortality. This study used data from a prospective cohort study of adults living in Alberta, Canada to examine factors associated with lung cancer stage at diagnosis.

Methods

This cohort study used data from adults aged 35–69 years enrolled in Alberta’s Tomorrow Project. Partial Proportional Odds models were used to examine associations between sociodemographic characteristics and health-related factors and subsequent lung cancer stage at diagnosis.

Results

A total of 221 participants (88 males and 133 females) developed lung cancer over the study period. Nearly half (48.0%) of lung cancers were diagnosed at a late stage (stage IV), whereas 30.8 % and 21.3% were diagnosed at stage I/II and III, respectively. History of sunburn in the past year was protective against late-stage lung cancer diagnosis (odds ratio (OR) .40, P=.005). In males, a higher number of lifetime prostate specific antigen tests was associated with reduced odds of late-stage lung cancer diagnosis (odds ratio .66, P=.02). Total recreational physical activity was associated with increased odds of late-stage lung cancer diagnosis (OR 1.08, P=.01).

Discussion

Lung cancer stage at diagnosis remains a crucial determinant of prognosis. This study identified important factors associated with lung cancer stage at diagnosis. Study findings can inform targeted cancer prevention initiatives towards improving early detection of lung cancer and lung cancer survival.

A visualized dynamic prediction model for survival of patients with geriatric thyroid cancer: A population-based study

OBJECTIVE

Thyroid cancer (TC) is a common malignancy with a poor prognosis with aging. However, no accurate predictive survival model exists for patients with geriatric TC.We aimed to establish prediction models of prognosis in elderly TC.

METHODS

We retrospectively reviewed the clinicopathology characteristics of patients with geriatric TC in the Surveillance, Epidemiology, and End Results database (SEER) from 2004 to 2018. The risk predictors used to build the nomograms were derived from the Cox proportional risk regression. These nomograms were used to predict 1-, 3-, and 5-year overall survival and cancer-specific survival in elderly patients with TC. The accuracy and discriminability of the new model were evaluated by the consistency index (C-index) and calibration curve. The clinical applicability value of the model was assessed using the decision curve analysis.

RESULTS

We used the SEER database to include 16475 patients with geriatric TC diagnosed from 2004 to 2018. The patients from 2004 to 2015 were randomly sorted out on a scale of 7:3. They were classified into a training group (n = 8623) and a validation group (n = 3669). Patients with TC diagnosed in 2016-2018 were classified into external validation groups (n = 4183). The overall survival nomogram consisted of 10 variables (age, gender, marital status, histologic type, grade, TNM stage, surgery status, and tumor size). A cancer-specific survival nomogram consisted of eight factors (age, tumor size, grade, histologic type, surgery, and TNM stage). The C-index values for the training, validation, and external validation groups were 0.775 (95% confidence interval [CI] 0.785-0.765), 0.776 (95% CI 0.792-0.760), and 0.895(95% CI 0.873-0.917), respectively. The overall survival was consistent with a nomogram based on the calibration curve. Besides, the decision curve analysis showed excellent clinical application value of the nomogram. Additionally, we found that surgery could improve the prognosis of patients with geriatric at high-risk (P < 0.001) but not those at low-risk (P = 0.069).

CONCLUSION

This was the first study to construct predictive survival nomograms for patients with geriatric TC. The well-established nomograms and the actual results could guide follow-up management strategies.

Characteristics of breast cancer patients at dr. Sardjito Hospital for early anticipation of neutropenia: Cross-sectional study

The highest prevalence of breast cancer in Indonesia is in the Province of Yogyakarta. dr. Sardjito General Hospital has quite complete clinical data on breast cancer patients. Characteristics of the population in various regions in Indonesia are different from one another. This problem is the basis for doing this research. Statistical data analysis needs to be done in each area for better diagnosis and treatment of cancer. Data recording is carried out continuously during outpatient treatment at dr. Sardjito General Hospital. Data for breast cancer patients was taken from July 2018 to June 2020. The data obtained were grouped into four categories: laboratory investigation, socio-demographic, clinical examination, and pathology. Descriptive and correlation analysis aims to determine the characteristics of breast cancer patients seeking treatment at dr. Sardjito General Hospital and anticipate their possibility of developing neutropenia after chemotherapy. The results of the descriptive analysis are significant to determine patient characteristics and treatment steps that can be taken. Correlation analysis variables closely related to neutrophils included leucocyte count, lymphocyte, monocyte, albumin, age at first diagnosis, and height. These variables can be a severe concern of medical personnel before undergoing chemotherapy, especially lymphocytes, which have the largest (negative) correlation and can be an early sign of neutropenia.

•

Characteristics of the population in various regions in Indonesia are different from one another.

•

Statistical data analysis needs to be done in each area for better diagnosis and treatment of cancer.

•

The results of the descriptive analysis are essential to determine patient statistics and the treatment steps taken.

•

The strong correlation with neutrophils are leukocytes, lymphocytes, monocytes, albumin, age, and height.

OUP accepted manuscript

Background

Methods

Results

Conclusions

The Impact of Smoking and Multiple Health Behaviors on All-Cause Mortality

Four common health risk behaviors have the greatest impact on all-cause mortality risk, but studies are needed with larger samples and the appropriate age range for cigarette smokers. We examined the impact of smoking in the context of multiple health behaviors on all-cause mortality using a nationally representative sample of adults aged 30 and older in the United States. National Health Interview Survey data from 1997 to 2005 were linked to the National Death Index with a follow-up to December 2015. The primary dependent variable was all-cause mortality, and the primary predictors were smoking, heavy drinking, physical inactivity, and unhealthy weight (underweight or obesity). The sample contained 189,087 individuals (≥ age 30; population estimate = 140.7 million). Our primary statistical analysis tool involved fitting Cox proportional hazards models. Our findings demonstrated that smoking led to the highest mortality risk among the four risk behaviors examined, but more than half of smokers engaged in at least one additional health risk behavior. Smokers who engaged in multiple health behaviors experienced higher increased mortality risks: smoking combined with one other health risk behavior increased mortality risk by 32% and by 82% when combined with two behaviors. Engaging in all four risk behaviors more than doubled the mortality risk of smokers. Smoking cessation interventions that address multiple risk behaviors-physical inactivity, heavy drinking, and unhealthy weight-will likely prevent premature death better than interventions that address only smoking.

Characterizing head and neck cancer survivors' discontinuation of survivorship care

BACKGROUND

Little is known about cancer survivors who discontinue survivorship care. The objective of this study was to characterize patients with head and neck cancer who discontinue survivorship care with their treating institution and identify factors associated with discontinuation.

METHODS

This was a retrospective cohort study of patients diagnosed with head and neck cancer between January 1, 2014, and December 31, 2016, who received cancer-directed therapy at the University of Iowa Hospitals and Clinics (UIHC). Eligible patients achieved a cancer-free status after curative-intent treatment and made at least 1 visit 90+ days after treatment completion. The primary outcome was discontinuation of survivorship care, which was defined as a still living survivor who had not returned to a UIHC cancer clinic for twice the expected interval. Demographic and oncologic factors were examined to identify associations with discontinuation.

RESULTS

Ninety-seven of the 426 eligible patients (22.8%) discontinued survivorship care at UIHC during the study period. The mean time in follow-up for those who discontinued treatment was 15.4 months. Factors associated with discontinuation of care included an unmarried status (P = .036), a longer driving distance to the facility (P = .0031), and a single-modality cancer treatment (P < .0001). Rurality was not associated with discontinuation (24.3% vs 21.6% for urban residence; P = .52), nor was age, gender, or payor status.

CONCLUSIONS

The study results indicate that a sizeable percentage of head and neck cancer survivors discontinue care with their treating institution. Both demographic and oncologic factors were associated with discontinuation at the treating institution, and this points to potential clinical and care delivery interventions.

Fertility and sexual dysfunction in young male cancer survivors

Background

Newly emerging serious post-treatment complications among young male cancer survivors involve fertility and sexual function, preventing them from pursuing a normal family life.

Methods

We studied and summarized published studies that assess the relationship between cancer treatments and reduced spermatogenesis or sexual dysfunction.

Main findings

Infertility often occurs because of anticancer therapies that impair spermatogenesis. While some patients postremission functionally recover fertility, others experience a decreased sperm count and azoospermia. Fertility-preserving modalities are currently being promoted worldwide to preserve spermatogenesis following cancer therapy. Patients who can ejaculate and have sperm in their semen should cryopreserve semen. However, for patients who have never ejaculated before puberty or in whom spermatogenesis has not been established, testis biopsy is performed to collect and preserve sperm or germ cells. Fertility preservation is gaining popularity and requires continuous information dissemination to oncologists and cancer treatment professionals. Furthermore, male sexual dysfunction predominantly involves erectile dysfunction and ejaculation disorder.

Conclusion

Although preventive and therapeutic methods for these disorders have been established within urology, patients and medical professionals in other fields remain uninformed of these advances. Therefore, dissemination of information regarding fertility preservation techniques should be accelerated.

Palliative non-small cell lung cancer treatment and end-of-life care stratified by sex and childlessness: an important interplay in unmarried patients?

PURPOSE

To analyze the interplay of sex and presence of children in unmarried patients with non-small cell lung cancer, because previous studies suggested sex-related disparities. Adult children may participate in treatment decisions and provision of social support or home care.

METHODS

Retrospective single-institution analysis of 186 unmarried deceased patients, managed according to national guidelines outside of clinical trials. Due to the absence of other oncology care providers in the region and the availability of electronic health records, all aspects of longitudinal care were captured.

RESULTS

Eighty-eight female and 98 male patients were included, the majority of whom had children. Comparable proportions in all four strata did not receive active therapy. Involvement of the palliative care team was similar, too. Patients without children were more likely to receive systemic therapy (39% utilization in women with children, 67% in women without children, 41% in men with children, 52% in men without children; p = 0.05). During the last 3 months of life, female patients spent significantly more days in hospital than their male counterparts. Place of death was not significantly different. Home death was equally uncommon in each group. In the multivariate analysis, survival was associated with age and cancer stage, in contrast to sex and presence of children.

CONCLUSION

In contrast to studies from other healthcare systems, unmarried male patients were managed in a largely similar fashion to their female counterparts and with similar survival outcome. Unexpectedly, patients without children more often received systemic anti-cancer treatment.

"Partner", "Caregiver", or "Co-Survivor"-Might the Label We Give the Partners of Cancer Patients Affect the Health Outcome of the Patients and Their Partners?

Having a life partner significantly extends survival for most cancer patients. The label given to the partners of cancer patients may, however, influence the health of not just the patients but their partners. "Caregiver" is an increasingly common label for the partners of patients, but it carries an implicit burden. Referring to partners as "caregivers" may be detrimental to the partnerships, as it implies that the individuals are no longer able to be co-supportive. Recognizing this, there has been some effort to relabel cancer dyads as "co-survivors". However, many cancer patients are not comfortable being called a "survivor", and the same may apply to their partners. Cancer survivorship, we argue, could be enhanced by helping keep the bond between patients and their partners strong. This includes educating patients and partners about diverse coping strategies that individuals use when facing challenges to their health and wellbeing. We suggest that preemptive couples' counselling in cancer centers may benefit both patients and their partners.

Effect of Marital Status on the Survival of Patients With Adenocarcinoma of the Esophagogastric Junction: A Population-Based, Propensity-Matched Study

Background

Marital status has been reported as an independent prognostic factor in various types of malignancies. However, the association between marital status and outcomes of patients with adenocarcinoma of the esophagogastric junction (AEG) has not been fully explored. To this end, we aimed to investigate the effect of marital status on survival of AGE patients.

Methods

The Surveillance Epidemiology and End Results (SEER) database (2010–2015) was used to extract eligible patients with Siewert type II AEG. Meanwhile, propensity score matching was performed to match 1576 unmarried patients with 1576 married patients. Kaplan–Meier method with log-rank test was used to plot survival curves, univariate and multivariate Cox regression analyses were adopted to investigate the association of marital status with overall survival (OS) and cancer-specific survival (CSS) in AEG patients before and after matching.

Results

Multivariate analysis in the unmatched cohort revealed that marital status was an independent prognostic factor in patients with Siewert type II AEG. Unmarried patients had poorer OS (hazard ratio [HR]: 1.22, 95% confidence interval [CI]: 1.12–1.29, P < .001) and poorer CSS (HR: 1.19, 95% CI: 1.10–1.29, P < .001) than married patients before matching. Additionally, widowed patients had the poorest OS (HR: 1.26, 95% CI: 1.11–1.44, P < .001) and CSS (HR: 1.29, 95% CI: 1.12–1.48, P < .001) compared with married patients. Furthermore, unmarried status remained as an independent prognostic for both OS (HR: 1.20, 95% CI: 1.10–1.31, P < .001) and CSS (HR: 1.18, 95% CI: 1.08–1.30, P < .001) in 1:1 propensity score-matched analysis. Subgroup analysis further revealed that OS and CSS rates were significantly higher in married patients than unmarried ones in most subgroups stratified by different variables.

Conclusions

This population-based study identified that marital status was an independent prognostic indicator for AEG patients. Married AEG patients had better prognosis than their unmarried counterparts.

Factors associated with colorectal cancer screening intent and uptake among adult Non-Hispanic Black men

Non-Hispanic (NH) Black men in the United States have the lowest five-year colorectal cancer (CRC) survival rate across all racial/ethnic and sex subgroups and are less likely than their NH White counterparts to complete CRC screening. We hypothesized that greater masculinity barriers to medical care (MBMC) would be negatively associated with CRC screening uptake. Employing a survey design, we examined the MBMC scale and other psychosocial factors influencing CRC screening intent and uptake in a sample of 319 NH Black men aged 45 to 75 years residing in Minnesota, Ohio, and Utah. A series of ordinary least squares and logistic regression models were run with intention and uptake as the outcome variable while controlling for various demographic characteristics. Independent variables in all models included average score on the MBMC; CRC screening knowledge, beliefs and values; and barriers to and social support for CRC screening. Social support, marital status, and age were positively associated with CRC screening intention. Increased CRC screening knowledge and older age were associated with a greater likelihood of completing a stool-based screening test for CRC. Fewer masculinity-related and CRC screening barriers were associated with a greater likelihood of undergoing a sigmoidoscopy or colonoscopy. Contrary to our primary hypothesis, lesser MBMC-related perceptions were associated with increased CRC screening uptake among NH Black men. Our findings inform future CRC promotion programs and emphasize the need for multilevel interventions tailored toward this marginalized population to reduce disparities in screening and survival.

Predicting Cancer-Specific Survival Among Patients With Prostate Cancer After Radical Prostatectomy Based on the Competing Risk Model: Population-Based Study

Introduction: We aimed to develop an easy-to-use individual survival prognostication tool based on competing risk analyses to predict the risk of 5-year cancer-specific death after radical prostatectomy for patients with prostate cancer (PCa).

Methods: We obtained the data from the Surveillance, Epidemiology, and End Results (SEER) database (2004–2016). The main variables obtained included age at diagnosis, marital status, race, pathological extension, regional lymphonode status, prostate specific antigen level, pathological Gleason Score. In order to reveal the independent prognostic factors. The cumulative incidence function was used as the univariable competing risk analyses and The Fine and Gray's proportional subdistribution hazard approach was used as the multivariable competing risk analyses. With these factors, a nomogram and risk stratification based on the nomogram was established. Concordance index (C-index) and calibration curves were used for validation.

Results: A total of 95,812 patients were included and divided into training cohort (n = 67,072) and validation cohort (n = 28,740). Seven independent prognostic factors including age, race, marital status, pathological extension, regional lymphonode status, PSA level, and pathological GS were used to construct the nomogram. In the training cohort, the C-index was 0.828 (%95CI, 0.812–0.844), and the C-index was 0.838 (%95CI, 0.813–0.863) in the validation cohort. The results of the cumulative incidence function showed that the discrimination of risk stratification based on nomogram is better than that of the risk stratification system based on D'Amico risk stratification.

Conclusions: We successfully developed the first competing risk nomogram to predict the risk of cancer-specific death after surgery for patients with PCa. It has the potential to help clinicians improve post-operative management of patients.

A Prognostic Nomogram for T3N0 Rectal Cancer After Total Mesorectal Excision to Help Select Patients for Adjuvant Therapy

Background

The recurrence rate of T3N0 rectal cancer after total mesorectal excision (TME) is relatively low, meaning that not all patients need adjuvant therapy (AT) (radiotherapy, chemotherapy, or chemoradiotherapy).

Methods

Patients diagnosed with pT3N0M0 rectal cancer after TME were analyzed using the SEER database, of which 4367 did not receive AT and 2794 received AT. Propensity score matching was used to balance the two groups in terms of confounding factors. Cox proportional hazards regression analysis was used to screen independent prognostic factors, which were then used to establish a nomogram. The patients were then divided into three groups with X-tile software according to their risk scores. We enrolled 334 patients as external validation.

Results

The C-index of the model was 0.725 (95% confidence interval: 0.694–0.756). We divided the patients into three different risk layers based on the nomogram prediction scores, and found that AT did not improve the prognosis of low- and moderate-risk patients, while high-risk patients benefited from AT. External validation data also support the above conclusions.

Conclusion

This study developed a nomogram that effectively and comprehensively evaluates the prognosis of T3N0 rectal cancer patients after TME. After using the nomogram, we recommend AT for high-risk patients, but not for low- and moderate-risk patients.

Prognostic Nomogram for Predicting Overall Survival of Solitary Bone Plasmacytoma Patients: A Large Population-Based Study

Background

The aim of the study was to develop a nomogram to predict the overall survival (OS) of patients with solitary plasmacytoma of bone (SBP).

Materials and Methods

Patients diagnosed with SBP between 1993 and 2012 were collected from the Surveillance, Epidemiology, and End Results (SEER) database. All eligible patients were randomly allocated to the training sets and the validation sets. The nomogram was developed with the training set and validated with the validation set using the concordance index (C-index), calibration plots, and decision curve analyses (DCA).

Results

Age, marital status, tumor grade, treatment were independent prognostic indicators for OS (P<0.05) and were integrated to construct the nomogram. C-indexes for OS prediction in the training and validation sets were 0.78 and 0.73, respectively. The calibration plots demonstrated good consistency between the predicted and actual survival. DCA demonstrated that the new model has great benefits. In the total cohort, the median OS of patients in the low- and high-risk groups were 12.17 (95% CI 11.92–12.42) and 3.92 (95% CI 2.83–5.01) years, respectively.

Conclusion

The nomogram showed excellent applicability and accuracy, which could be a reliable tool for predicting OS in SBP patients.

The Chinese version of the Revised Dyadic Adjustment Scale for gynaecological cancer patients and their partners: Translation and psychometric evaluation

Objective

The objective of the study was to translate the revised dyadic adjustment scale into Chinese and evaluate its psychometric properties in gynaecological cancer patients and their male partners.

Methods

A cross-sectional design with a random subsample re-tested at the one-week interval was adopted. Gynaecological cancer patients and their partners were asked to complete the Chinese version of the revised dyadic adjustment and quality of marriage index. Internal consistency, test-retest reliability, convergent validity, structural validity and known-group validity was assessed.

Results

A total of 252 participants (i.e., 126 female patients and 126 male partners) were recruited. The Chinese version of the Revised Dyadic Adjustment showed good internal consistency (Cronbach's α ​= ​0.85), test–retest reliability (r ​= ​0.88), known group validity and adequate convergent validity with a significant positive correlation (r ​= ​0.60) with the Quality of Marriage Index. Confirmatory factor analysis indicated an acceptable model fit to a second-order three-factor structure (GFI ​= ​0.913, RMR ​= ​0.046, CFI ​= ​0.932).

Conclusions

The Chinese version of revised dyadic adjustment demonstrated good reliability and acceptable validity in gynaecological cancer patients and male partners. The scale can be used to assess the effectiveness of clinical nursing services for couples on their relationship and to compare marital satisfaction and adjustment between China and other parts of the world.

Sociodemographic and Geographic Disparities of Prostate Cancer Treatment Delay in Tennessee: A Population-Based Study

The relationship of social determinants of health, Appalachian residence, and prostate cancer treatment delay among Tennessee adults is relatively unknown. We used multivariate logistic regression on 2005–2015 Tennessee Cancer Registry data of adults aged ≥18 diagnosed with prostate cancer. The outcome of treatment delay was more than 90 days without surgical or nonsurgical intervention from date of diagnosis. Social determinants in the population-based registry were race (White, Black, Other) and marital status (single, married, divorced/separated, widow/widower). Tennessee residence was classified as Appalachian versus non-Appalachian (urban/rural). Covariates include age at diagnosis (18–54, 54–69, ≥70), health insurance type (none, public, private), derived staging of cancer (localized, regional, distant), and treatment type (non-surgical/surgical). We found that Black and divorced/separated patients had 32% (95% confidence interval [CI]: 1.22–1.42) and 15% (95% CI: 1.01–1.31) increased odds to delay prostate cancer treatment. Patients were at decreased odds of treatment delay when living in an Appalachian county, both urban (odds ratio [OR] = 0.89, 95% CI: 0.82–0.95) and rural (OR = 0.83, 95% CI: 0.78–0.89), diagnosed at ≥70 (OR = 0.59, 95% CI: 0.53–0.66), and received surgical intervention (OR = 0.72, 95% CI: 0.68–0.76). Our study was among the first to comprehensively examine prostate cancer treatment delay in Tennessee, and while we do not make clinical recommendations, there is a critical need to further explore the unique factors that may propagate disparities. Prostate cancer treatment delay in Black patients may be indicative of ongoing health and access disparities in Tennessee, which may further affect quality of life and survivorship among this racial group. Divorced/separated patients may need tailored interventions to improve social support.

Predictors of CRC Stage at Diagnosis among Male and Female Adults Participating in a Prospective Cohort Study: Findings from Alberta's Tomorrow Project

Colorectal cancer (CRC) is a leading cause of morbidity and mortality in Canada. CRC screening and other factors associated with early-stage disease can improve CRC treatment efficacy and survival. This study examined factors associated with CRC stage at diagnosis among male and female adults using data from a large prospective cohort study in Alberta, Canada. Baseline data were obtained from healthy adults aged 35–69 years participating in Alberta’s Tomorrow Project. Factors associated with CRC stage at diagnosis were evaluated using Partial Proportional Odds models. Analyses were stratified to examine sex-specific associations. A total of 267 participants (128 males and 139 females) developed CRC over the study period. Among participants, 43.0% of males and 43.2% of females were diagnosed with late-stage CRC. Social support, having children, and caffeine intake were predictors of CRC stage at diagnosis among males, while family history of CRC, pregnancy, hysterectomy, menopausal hormone therapy, lifetime number of Pap tests, and household physical activity were predictive of CRC stage at diagnosis among females. These findings highlight the importance of sex differences in susceptibility to advanced CRC diagnosis and can help inform targets for cancer prevention programs to effectively reduce advanced CRC and thus improve survival.

Social Support is Associated with Survival in Patients Diagnosed with Gastrointestinal Cancer

PURPOSE

The aim of this study was to examine the link between psychological, behavioral, and social factors and survival in patients diagnosed with gastrointestinal cancer.

METHODS

A cohort of gastrointestinal cancer patients were administered a battery of questionnaires that assessed trauma, depression, social support, sleep, diet, exercise, quality of life, tobacco and alcohol use, pain, and fatigue. Analyses included Pearson's correlations, analyses of variance, Kaplan Meier survival, and Cox regression analyses.

RESULTS

Of the 568 patients, the majority were male (57.9%) and Caucasian (91.9%), with a mean age of 61 (S.D. = 10.7). The level of perceived social support was comparable to patients with other medical conditions. Sociodemographic predictors of social support included the number of years of education (r = 0.109, p = 0.05), marital status (F(6,387) = 5.465, p ≤ 0.001), and whether the patients' income met the family's basic needs (F(1,377) = 25.531, p < 0.001). Univariate analyses revealed that older age (p < 0.001), male gender (p = 0.007), being black (p = 0.005), diagnosis of hepatocellular carcinoma (p = 0.046), higher body mass index (p = 0.022), larger tumor size (p = 0.032), initial treatment including chemotherapy rather than surgery (p < 0.001), and lower level of perceived social support (p = 0.037) were associated with poorer survival. Using multivariate Cox regression and adjusting for all factors found to be significant in univariate survival analyses, older age (p = 0.024) and lower perceived social support (HR = 0.441, 95% CI = 0.233, 0.833; p = 0.012) were the factors that remained significantly associated with poorer survival.

CONCLUSION

There are several biological and psychosocial factors that predict cancer mortality. Social support appears to be a robust factor affecting mortality in gastrointestinal cancer patients.

Mortality in cancer patients with congenital anomalies across different age groups: trend analysis and prognostic risk factors.. [DOI: 10.1101/2021.11.20.21266629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

Purpose

Congenital anomalies are one of the causes of the high mortality rate in children diagnosed with cancer. However, there is a gap of evidence of the rate of cancer mortality in older patients who had congenital anomalies. The study, therefore, aimed to investigate the epidemiology of cancer mortality in those patients.

Methods

Data were retrieved for patients with cancer and died due to congenital causes throughout 43 years from Surveillance, Epidemiology, and End Results program SEER. The age of patients was divided into nine groups each is formed of 10 years interval. Joinpoint analysis was used to calculate the trends of Cancer mortality and Cox proportional hazard ratio to identify the mortality risk factors.

Results

We have included 2682 patients with death associated with congenital malformation. The mortality of cancer patients due to congenital anomalies greatly enhanced in the last years with the overall average annual percent was 3.8%. Interestingly, congenital anomalies had less mortality risk than other causes reported in SEER. Moreover, age, sex, radiation, chemotherapy, and behavior of tumor were significantly associated with higher survival in patients with congenital anomalies.

Conclusions

Cancer patients with congenital anomalies had less mortality risk than patients with other diseases reported in SEER. The mortality rates decreased recently, with the most mortality in the bone marrow and prostate tumors.

Implications for Cancer Survivors

Congenital anomalies are considered the least studied diseases in cancer patients. In this study, we studied how congenital anomalies did not increase the risk for cancer. However, our analysis implied the congenital anomalies in the male reproductive system were associated with the highest risk of cancer.

Initial findings from a prospective, large scale patient reported outcomes program in patients with gynecologic malignancy

INTRODUCTION

Patient reported outcome measures (PROMs) are associated with improved overall survival in patients with metastatic malignancy; however, routine collection of PROMs is nascent. Little is known about PROs in women with gynecologic malignancy outside of a trial setting, limiting our understanding of how routine populations experience treatment, disease and morbidity. The goal of this study was to prospectively collect and describe disease-specific PROs in a non-trial population of women with gynecologic malignancy.

METHODS

PROMs were assigned electronically to all patients presenting for care in our gynecologic oncology clinic. Patients received a general oncology questionnaire (EORTC QLQ C30) a disease specific questionnaire (FACT V, EORTC EN24, EORTC OV28, EORTC Cx 24), and questionnaires assessing support at home. Responses were mapped to relevant clinical variables. Descriptive statistics were performed, and comparisons made with parametric and nonparametric analyses. The association between support at home and perioperative complications was assessed via logistic regression.

RESULTS

In the study period, 3239 unique patients were evaluated at new patient visits, post-operative visits, chemotherapy visits and surveillance visits with a PROMs completion rate of 78.1% (n = 2530 women with 4402 completions). There was no difference in completion rates based on age or self-identified race. The EORTC QLQ C-30 questionnaire was able to adequately discern differences between disease sites. Overall, scores were lower than those obtained in trial populations. PROMs responses were not associated with perioperative complications.

CONCLUSION

Systematic collection of PROMs is feasible and tech-enabled workflows result in high collection rates. Quality of life scores in our clinic population were lower than published data, indicating caution should be used when extrapolating quality of life data from clinical trials to counseling and decision making around routine patient populations.

Drug use disorder and risk of incident and fatal prostate cancer among Swedish men: a nationwide epidemiological study

Purpose

Prostate cancer is the second most common cancer in men and a leading cause of cancer mortality worldwide. Men with drug use disorders (DUD) may potentially be at high risk for prostate cancer mortality because of delayed diagnosis and/or undertreatment. In this study, we aimed to investigate prostate cancer incidence, mortality, and stage at time of diagnosis among men with DUD compared to the general male population in Sweden.

Methods

We performed a follow-up study based on Swedish national register data for the period January 1997–December 2016. The study was based on 1,361,532 men aged 50–75 years at inclusion, of whom 9,259 were registered with DUD. Cox regression analysis was used to compute adjusted hazard ratios (HRs) for incident and fatal prostate cancer, and cancer stage at time of diagnosis, associated with DUD.

Results

DUD was associated with a slightly increased risk of incident prostate cancer (HR: 1.07, 95% confidence interval [CI] 1.00–1.14, p = 0.048) and substantially higher risk of fatal prostate cancer (HR: 1.59, 95% CI 1.40–1.82, p < 0.001), adjusted for age, socioeconomic factors, and comorbidities related to tobacco smoking and alcohol use disorder. No association was found between DUD and prostate cancer stage at diagnosis.

Conclusions

Men with DUD have an increased risk of fatal prostate cancer, possibly related to undertreatment in this patient population. Our findings should raise attention among medical staff and decision-makers towards a disadvantaged group of men in need of easily accessible prostate cancer evaluation and treatment.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10552-021-01513-2.

Models of support to family members during the trajectory of cancer: A scoping review

AIMS AND OBJECTIVES

To map the existing literature on support models provided to family members during the cancer trajectory.

BACKGROUND

Cancer diagnosis, treatment and survivorship have a profound influence on the surrounding family members. This scoping review is part of the development of a support model for family members of persons diagnosed with colorectal cancer.

DESIGN

The method was guided by the Arksey and O'Malley framework, described in the Joanna Briggs Institute guidelines, and the reporting is compliant with PRISMA-ScR Checklist. Searches were conducted in PubMed, CINAHL and PsycINFO from November 2019-February 2020 with no limitation in publication year or study design. Complementing searches were conducted in reference lists and for grey literature, followed by an additional search in September 2020. Inclusion criteria were primary research about support provided by health care, to family members, during cancer, of an adult person, in Swedish or English, of moderate or high methodological quality. Quality was assessed using the Joanna Briggs Institute critical appraisal tools. Data were extracted using a charting form.

RESULT

A total of 32 studies were included in the review describing 39 support models.

CONCLUSION

The mapping of the existing literature resulted in the identification of three themes of support models: psychoeducation, caregiver training and psychological support. In addition, that future research should target a specific diagnosis and trajectory phase as well as include family members and intervention providers in model development.

RELEVANCE FOR CLINICAL PRACTICE

Knowledge from the literature on both the needs of the family members and existing support models should be incorporated with the prerequisites of clinical practice. Clinical practice should also be complemented with structured assessments of family members' needs conducted regularly.

Yoga is effective in treating symptoms of Gulf War illness: A randomized clinical trial

Many Veterans of the 1990-1991 Gulf War report symptoms of Gulf War Illness, a condition involving numerous chronic symptoms including pain, fatigue, and mood/cognition symptoms. Little is known about this condition's etiology and treatment. This study reports outcomes from a randomized controlled single-blind trial comparing yoga to cognitive behavioral therapy for chronic pain and other symptoms of Gulf War Illness. Participants were Veterans with symptoms of GWI: chronic pain, fatigue and cognition-mood symptoms. Seventy-five Veterans were randomized to treatment via selection of envelopes from a bag (39 yoga, 36 cognitive behavioral therapy), which consisted of ten weekly group sessions. The primary outcomes of pain severity and interference (Brief Pain Inventory- Short Form) improved in the yoga condition (Cohen's d = .35, p = 0.002 and d = 0.69, p < 0.001, respectively) but not in the CBT condition (d = 0.10, p = 0.59 and d = 0.25 p = 0.23). However, the differences between groups were not statistically significant (d = 0.25, p = 0.25; d = 0.43, p = 0.076), though the difference in an a-priori-defined experimental outcome variable which combines these two variables into a total pain variable (d = 0.47, p = 0.047) was significant. Fatigue, as indicated by a measure of functional exercise capacity (6-min walk test) was reduced significantly more in the yoga group than in the CBT group (between-group d = .27, p = 0.044). Other secondary outcomes of depression, wellbeing, and self-reported autonomic nervous system symptoms did not differ between groups. No adverse events due to treatment were reported. Yoga may be an effective treatment for core Gulf War Illness symptoms of pain and fatigue, making it one of few treatments with empirical support for GWI. Results support further evaluation of yoga for treating veterans with Gulf War Illness. CLINICAL TRIAL REGISTRY: clinicaltrials.gov Registration Number NCT02378025.

Effects of marital status on survival of medullary thyroid cancer stratified by age

Purpose

Marital status has emerged as an important influence on several cancer outcomes, but its role in medullary thyroid cancer (MTC) remains unclear. This study was to explore the effects of marital status on the prognosis of MTC patients and to determine whether its effects vary by age.

Patients and methods

We retrospectively extracted 1344 eligible patients diagnosed with MTC between 2004 and 2015 from the Surveillance, Epidemiology, and End Results (SEER) database. Based on the marital status, we divided those patients into married and unmarried groups. We compared the difference in overall survival (OS) and cancer‐specific survival (CSS) between married and unmarried via the Kaplan–Meier analysis. Univariate and multivariate Cox proportional models were performed to identify the prognostic factors of OS and CSS.

Results

There were 1344 MTC eligible patients in a total of which 883 (65.7%) were married and 461 (34.3%) were unmarried. The comparison observed between married and unmarried patients was as follows: male (45.2% vs. 28.0%), age (≥52 years) (55.9% vs. 44.6%), White (86.7% vs. 78.7%), and undergo surgery (97.7% vs. 93.3%). Multivariate analysis revealed unmarried status as a risk factor independently associated with worse OS (HR: 2.15, 95% CI: 1.59–2.92) rate and CSS (HR: 1.70, 95% CI: 1.17–2.47) rate. In a further analysis stratified by age, there was no significant difference in OS and CSS between married and unmarried patients younger than 52 years. For the remaining group with 52 years old and higher, unmarried patients showed significantly higher risk of OS and CSS than married patients at all stages of the pathology except M1 stage.

Conclusion

Married patients with MTC have a better prognosis than unmarried ones. Age can affect the association between marital status and the survival of MTC, and married elders may benefit more than youngers.

Exploring dyadic management of nutrition care throughout and beyond head and neck cancer treatment

AIMS AND OBJECTIVES

To identify how patients and carers collaborate to manage nutrition care throughout and beyond head and neck cancer (HNC) treatment as a step towards identifying changes to service delivery that are inclusive of the needs of the patient-carer dyad.

BACKGROUND

Research in the field of dyadic interventions in cancer care is emerging, and there has been little work exploring patient-carer dyad needs in the provision of nutrition care in HNC.

DESIGN

A qualitative study design was used.

METHODS

Narrative interviews were completed with 13 patients and 15 carers over a 12-month period (prior to treatment commencing, and 2 weeks, 3 months and 12 months post-treatment completion). Deductive analysis of interview transcripts was performed using directed content analysis guided by the Theory of Dyadic Illness Management (TDIM). COREQ guidelines were used.

RESULTS

Seven themes across four TDIM constructs were identified: (1) understanding and adapting to physical challenges impacting nutrition intake, (2) adjusting to emotional impact of changes to eating and drinking, (3) providing practical support, (4) intrapersonal characteristics, (5) interpersonal characteristics, (6) healthcare culture and (7) managing carer burnout.

CONCLUSION

This study highlights the importance of healthcare professionals recognising the patient and carer dyad as a team to enhance engagement in nutrition care and to ensure that their physical and psychological support needs across the cancer continuum are met.

RELEVANCE TO CLINICAL PRACTICE

It is important that healthcare professionals understand information and support needs and preferences within patient-carer dyads prior to HNC treatment commencing and adapt care and interventions based on their changing needs throughout and beyond the treatment period.

Real-World Utilization of Oral Anticancer Agents and Related Costs in Older Adults with Metastatic Renal Cell Carcinoma in the United States

BACKGROUND

Substantial racial and socioeconomic disparities in metastatic RCC (mRCC) have persisted following the introduction of targeted oral anticancer agents (OAAs). The relationship between patient characteristics and OAA access and costs that may underlie persistent disparities in mRCC outcomes have not been examined in a nationally representative patient population.

METHODS

Retrospective SEER-Medicare analysis of patients diagnosed with mRCC between 2007-2015 over age 65 with Medicare part D prescription drug coverage. Associations between patient characteristics, OAA receipt, and associated costs were analyzed in the 12 months following mRCC diagnosis and adjusted to 2015 dollars.

RESULTS

2,792 patients met inclusion criteria, of which 32.4%received an OAA. Most patients received sunitinib (57%) or pazopanib (28%) as their first oral therapy. Receipt of OAA did not differ by race/ethnicity or socioeconomic indicators. Patients of advanced age (> 80 years), unmarried patients, and patients residing in the Southern US were less likely to receive OAAs. The mean inflation-adjusted 30-day cost to Medicare of a patient's first OAA prescription nearly doubled from $3864 in 2007 to $7482 in 2015, while patient out-of-pocket cost decreased from $2409 to $1477.

CONCLUSION

Race, ethnicity, and socioeconomic status were not associated with decreased OAA receipt in patients with mRCC; however, residing in the Southern United States was, as was marital status. Surprisingly, the cost to Medicare of an initial OAA prescription nearly doubled from 2007 to 2015, while patient out-of-pocket costs decreased substantially. Shifts in OAA costs may have significant economic implications in the era of personalized medicine.

Stress-buffering effect of social support on immunity and infectious risk during chemotherapy for breast cancer

Objective

This study investigated the stress-buffering effect of social support on immune function and infectious risk in women with breast cancer, during and after chemotherapy.

Method

Data were collected from 50 women with breast cancer before and after their chemotherapy, as well as three months later. Stress was measured by daily hassles related to cancer and social support by marital status (MS) and perceived support from friends (Ps-fr). Blood was collected to measure innate immune markers (i.e., T cells, NK cells and neutrophils). Infections were evaluated using a semi-structured interview. Moderation, mediation and moderated mediation models were computed to test the hypotheses.

Results

Higher stress at baseline was found to significantly predict a higher occurrence of infections during chemotherapy, but not three months later. The relationship between stress and infections was not significantly explained by any of the immune markers. The interaction between stress and social support was tested using MS alone and combined with Ps-fr. A protective effect of social support on the deleterious effect of stress on infectious risk was found. Single patients reporting lower Ps-fr showed the strongest association between stress and infections, while the weakest association was found in patients in a committed relationship with a higher level of Ps-fr.

Conclusions

Women experiencing more stress before the beginning of chemotherapy would appear to be at a higher risk of developing infections during their treatment. Results of this study also suggest that this effect could be buffered by the presence of a romantic partner and by higher Ps-fr.

Socioeconomic position and prognosis in premenopausal breast cancer: a population-based cohort study in Denmark

BACKGROUND

To investigate how socioeconomic position (SEP) influences the effectiveness of cancer-directed treatment in premenopausal breast cancer patients in terms of breast cancer recurrence and mortality.

METHODS

We conducted a cohort study nested in the ProBeCaRe (Predictors of Breast Cancer Recurrence) cohort (n = 5959). We identified all premenopausal women aged 18-55 years diagnosed with non-metastatic breast cancer and prescribed docetaxel-based chemotherapy in Denmark during 2007-2011. Population-based administrative registries provided data on SEP: marital status (married including registered partnership or single including divorced or widowed), cohabitation (cohabiting or living alone), education (low, intermediate, or high), income (low, medium, or high), and employment status (employed, unemployed, or health-related absenteeism). For each SEP measure, we computed incidence rates, cumulative incidence proportions (CIPs), and used Poisson regression to compute incidence rate ratios (IRRs) and 95% confidence intervals (CIs) of recurrence and death. We stratified on estrogen receptor (ER) status/tamoxifen to evaluate interaction.

RESULTS

Our study cohort included 2616 women; 286 (CIP 13%) experienced recurrence and 223 (CIP 11%) died during follow-up (median 6.6 and 7.2 years, respectively). Single women had both increased 5-year risks of recurrence (IRR 1.45, 95% CI 1.11-1.89) and mortality (IRR 1.83, 95% CI 1.32-2.52). Furthermore, we observed increased 5-year mortality in women with low education (IRR 1.49, 95% CI 0.95-2.33), low income (IRR 1.37, 95% CI 0.83-2.28), unemployment (IRR 1.61, 95% CI 0.83-3.13), or health-related work absenteeism (IRR 1.80, 95% CI 1.14-2.82), but smaller or no increased risk of recurrence. These findings were especially evident among women with ER+ tumors prescribed tamoxifen. Overall analyses (follow-up max. 10 years) provided similar results.

CONCLUSIONS

Low SEP in premenopausal women with non-metastatic breast cancer was associated with increased mortality, but not always recurrence. This suggests underdetection of recurrences in certain groups. Poor prognosis in women with low SEP, especially single women, may partly be explained by tamoxifen adherence.

Spousal emotional support and relationship quality buffers pupillary response to horror movies

Being satisfied in marriage provides protective stress buffering benefits to various health complications but the causal mechanisms and speed at which this is accomplished is less well understood. Much of the research on health and marriage has conceptualized marital quality in a unidimensional way, with high levels of either positivity or negativity. This conceptualization may not fully capture the nuanced benefits of marital relationships. Pupillometry is an innovative method which captures the effects of marital stress buffering on the body’s autonomic nervous system in real time; pupil dilation occurs within 200ms to stress exposure. Additionally, this method records hundreds of readings per second, providing precision and sensitivity. This preregistered experiment aimed to conceptually replicate previous pupillometry stress buffering results and extend the previous findings by including a generalizable, real-life stressor—viewing a horror movie—and multidimensional relationship quality effects. Eighty-three couples (166 participants) were quasi-grouped, based on a self-reported multidimensional relationship quality scale, to either supportive or ambivalent marital relationship conditions. They were then randomly assigned to either a spousal support (i.e., handholding) or non-support (spousal absence) condition and watched clips from both horror and nature movies while pupil dilation was measured. Tonic pupillary response results revealed that the horror video clips elicited a stress response and there were significant differences between the support and non-support conditions, as well as marital relationship quality conditions. These results frame the precision, speed, and sensitivity of pupillometry as a potentially fruitful method to investigate the causal mechanisms linking stress buffering and supportive marital relationships.

Predictive Model for Overall Survival and Cancer-Specific Survival in Patients with Esophageal Adenocarcinoma

OBJECTIVE

Recent years, there has been a rapid increase in the incidence of esophageal adenocarcinoma (EAC), while the prognosis for patients diagnosed remains poor and has slightly improved.

METHODS

We extracted 6,466 cases with detailed demographical characteristics including age at diagnosis, sex, ethnicity, marital status, and clinical features, involving tumor grade and stage at diagnosis and treatment modalities (radiation therapy, chemotherapy, and surgery) from the Surveillance, Epidemiology, and End Results (SEER) (1975-2017) dataset. They were further randomly divided into the training and validating cohorts. Univariate and multivariate Cox analyses were conducted to determine significant variables for construction of nomogram. The predictive power of the model was then assessed by Harrell concordance index (C-index) and the area under the curve (AUC) of the receiver operating characteristic (ROC) curve.

RESULTS

Multivariate analysis revealed that age, marital status, insurance, tumor grade, TNM stage, surgery, and chemotherapy all showed a significant association with overall survival (OS) and cancer-specific survival (CSS). These characteristics were employed to build a nomogram. Particularly, the discrimination of nomogram for OS and CSS prediction in the training set were excellent (C-index = 0.762, 95% CI: 0.754-0.770 and C-index = 0.774, 95% CI: 0.766-0.782). The AUC of the nomogram for predicting 2- and 5-year OS was 0.834 and 0.853 and CSS was 0.844 and 0.866. Similar results were observed in the internal validation set.

CONCLUSION

We have successfully established a novel nomogram for predicting OS and CSS in EAC patients with good accuracy, which can help clinicians predict the survival of individual patient survival and provide optimal treatment strategies.

The Dyadic Cancer Outcomes Framework: A general framework of the effects of cancer on patients and informal caregivers

It is widely acknowledged that cancer affects not only patients but also their friends and family members who provide informal, and typically unpaid, care. Given the dual impact that cancer often has on patients and their informal caregivers (i.e., family members, partners, or friends), an expanded dyadic framework that encompasses a range of health and psychosocial outcomes and includes primary caregivers with a range of relationships to the patients is critically needed. Moreover, an emphasis on the role of social and contextual factors may help the framework resonate with a broader range of patient-caregiver relationships and allow for the development of more effective dyadic interventions. This article describes the development of the Dyadic Cancer Outcomes Framework, which was created to guide future research and intervention development. Using an iterative process, we conducted a conceptual review of currently used dyadic and/or caregiving models and frameworks and developed our own novel dyadic framework. Our novel Dyadic Cancer Outcomes Framework highlights individual- and dyad-level predictors and outcomes, as well as incorporating the disease trajectory and the social context. This framework can be used in conjunction with statistical approaches including the Actor Partner Interdependence Model to evaluate outcomes for different kinds of partner-caregiver dyads. This flexible framework can be used to guide intervention development and evaluation for cancer patients and their primary caregivers, with the ultimate goal of improving health, psychosocial, and relationship outcomes for both patients and caregivers. Future research will provide valuable information about the framework's effectiveness for this purpose.

Association of marital status with stage and survival in patients with mycosis fungoides: A population-based study

BACKGROUND

Previous studies have shown that marital status was associated with stages and survival in patients with melanoma or Merkel cell carcinoma. To date, the impacts of marital status on stage and survival in patients with mycosis fungoides (MF) have not been determined yet.

METHODS

A total of 3375 eligible cases diagnosed from 2004 to 2015 were included from the Surveillance, Epidemiology, and End Results (SEER) database. Association of marital status with stage and survival in patients with MF was analyzed.

RESULTS

Married patients were more likely to be diagnosed at T1 stage (p = 0.041). And married patients were less likely to present with lymph node involvement (p = 0.007). More favorable overall survival (p < 0.001) and cancer-specific survival (p < 0.001) were demonstrated in married patients as compared with divorced patients or widowed patients. A clinically feasible prognostic model including marital status, age, sex, race, and stage at presentation was constructed.

CONCLUSION

Married marital status was associated with earlier stage at diagnosis and longer survival compared with divorced or widowed marital status in patients with MF.