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Motomura Y, Urai S, Bando H, Yamamoto M, Suzuki M, Yamamoto N, Iguchi G, Ogawa W, Fukuoka H. Diagnostic dilemma in Cushing's syndrome: discrepancy between patient-reported and physician-assessed manifestations. Endocrine 2024; 86:417-427. [PMID: 39037671 PMCID: PMC11445276 DOI: 10.1007/s12020-024-03935-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 06/14/2024] [Indexed: 07/23/2024]
Abstract
PURPOSE Early diagnosis and immediate treatment of Cushing's syndrome (CS) are critical for a better prognosis but remain a challenge. However, few comprehensive reports have focused on this issue or investigated whether patient-reported manifestations are consistent with physician-assessed symptoms of CS. This study aimed to clarify the differences in patient-reported and physician-assessed manifestations of signs and symptoms of CS that prevent early diagnosis. METHODS This single-center retrospective study included 52 patients with CS (16 with Cushing's disease and 36 with adrenal CS). Upon clinical diagnosis, medical records were used to independently review the patient-reported and physician-assessed manifestations of typical (such as purple striae and proximal myopathy) and nonspecific features (such as hirsutism and hypertension). The correlations and differences between the patient-reported and physician-assessed manifestations were then analyzed. RESULTS We observed a positive correlation between the total number of manifestations of nonspecific features reported by patients and those assessed by physicians, but not for typical features. Moreover, manifestations reported by the patients were less frequent than those assessed by physicians for typical features, leading to discrepancies between the two groups. In contrast, there were no differences in most nonspecific features between the patient-reported and physician-assessed manifestations. Notably, the concordance between patient-reported and physician-assessed manifestations of typical features was not associated with urinary free cortisol levels. CONCLUSION Regardless of disease severity, patients often do not complain of the typical features of CS that are crucial for formulating a diagnosis.
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Affiliation(s)
- Yuma Motomura
- Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, 650-0017, Japan
| | - Shin Urai
- Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, 650-0017, Japan
| | - Hironori Bando
- Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Hospital, Kobe, Hyogo, 650-0017, Japan
| | - Masaaki Yamamoto
- Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, 650-0017, Japan
| | - Masaki Suzuki
- Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, 650-0017, Japan
| | - Naoki Yamamoto
- Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, 650-0017, Japan
| | - Genzo Iguchi
- Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, 650-0017, Japan
- Medical Center for Student Health, Kobe University, Kobe, Hyogo, 657-8501, Japan
- Department of Biosignal Pathophysiology, Kobe University Graduate School of Medicine, Kobe, Hyogo, 657-8501, Japan
| | - Wataru Ogawa
- Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, 650-0017, Japan
| | - Hidenori Fukuoka
- Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Hospital, Kobe, Hyogo, 650-0017, Japan.
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Reiner AS, Knight JA, John EM, Lynch CF, Malone KE, Liang X, Woods M, Root JC, Bernstein JL. Reply to "Critical analysis of Reiner et al.'s study on agreement of medical record abstraction and self-report of breast cancer treatment". Cancer 2024. [PMID: 39233462 DOI: 10.1002/cncr.35549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2024] [Accepted: 08/17/2024] [Indexed: 09/06/2024]
Affiliation(s)
- Anne S Reiner
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Julia A Knight
- Prosserman Center for Population Health Research, Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Esther M John
- Department of Epidemiology & Population Health, Stanford University School of Medicine, Stanford, California, USA
- Department of Medicine, Division of Oncology, Stanford University School of Medicine, Stanford, California, USA
| | - Charles F Lynch
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa, USA
| | - Kathleen E Malone
- Division of Public Health Science, Epidemiology Program, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Xiaolin Liang
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Meghan Woods
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - James C Root
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
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Thomas J, Snih SA. Liver disease, heart failure, and 13-year mortality among Mexican American older adults: Nativity differences. Ann Epidemiol 2024; 96:97-102. [PMID: 38141743 PMCID: PMC11192853 DOI: 10.1016/j.annepidem.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 12/13/2023] [Accepted: 12/19/2023] [Indexed: 12/25/2023]
Abstract
PURPOSE To examine nativity differences of co-occurring liver disease (LD) and heart failure (HF) on 13-year mortality among Mexican American older adults. METHODS Prospective cohort study of 1601 Mexican Americans aged ≥ 75 years from the Hispanic Established Population for the Epidemiologic Study of the Elderly (2004/05-2016). Participants were grouped into four groups: no LD and no HF (n = 1138), LD only (n = 53), HF only (n = 382), and both LD and HF (n = 28). We used Cox proportional hazards regression model to estimate the hazard ratio (HR) and 95% confidence interval (CI) of death over time. RESULTS The HR of death, as a function of HF only, was 1.32 (95% CI=1.07-1.62) among US-born and 1.36 (95% CI=1.04-1.78) among foreign-born participants, vs. those with no LD and no HF. Among foreign-born participants, the HR of death as a function of LD and HF was 3.39 (95% CI=1.65-6.93) vs. those without either. LD alone was not associated with mortality in either group. Among US-born, co-occurring LD and HF was not associated with mortality. CONCLUSIONS Foreign-born participants with both LD and HF were at higher risk of mortality over 13 years of follow up.
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Affiliation(s)
- Janice Thomas
- John Sealy School of Medicine, The University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555, USA; Department of Population Health and Health Disparities, School of Public and Population Health, The University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555, USA
| | - Soham Al Snih
- Department of Population Health and Health Disparities, School of Public and Population Health, The University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555, USA; Division of Geriatrics & Palliative Medicine, Department of Internal Medicine, The University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555, USA; Sealy Center on Aging, The University of Texas Medical Branch, 301 University Blvd., 77555 Galveston, TX, USA.
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D'Souza A, Szabo A, Akinola I, Finkel M, Flynn KE. Development and initial validation of the AL-PROfile patient-reported outcome measure in light chain (AL) amyloidosis. Eur J Haematol 2024; 112:900-909. [PMID: 38350661 PMCID: PMC11271248 DOI: 10.1111/ejh.14183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/19/2024] [Accepted: 01/22/2024] [Indexed: 02/15/2024]
Abstract
OBJECTIVE To evaluate the psychometric properties of the AL-PROfile, a patient-reported outcome measure combining the Patient-Reported Outcomes Measurement Information System (PROMIS)-29, two items from PROMIS Cognitive Function, and select Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE) items. METHODS Content validity was assessed through cognitive debriefing interviews of 20 patients who completed the AL-PROfile (Study 1). Study 2 involved 297 participants who completed the AL-PROfile and Medical Outcomes Study 36-item Short-Form Health Survey (SF-36). Reliability (internal consistency and test-retest reliability) and validity (convergent and discriminant validity, known groups validity by stage/organ involvement) were calculated. RESULTS Study 1 participants found the AL-PROfile straightforward confirming the relevance of the included content. Some felt that certain questions were not related to their amyloidosis experience. Study 2 demonstrated acceptable internal consistency for all domains/items except PROMIS Cognitive Function and acceptable test-retest reliability for all except PROMIS Cognitive Function and PRO-CTCAE nausea. Large correlations were seen for the same domain across measures while correlations for divergent domains within a measure and different domains across different measures were small. The PRO-CTCAE items showed small to medium correlations with each other and with PROMIS and SF-36 domains. Stage was associated with physical function, fatigue, social roles, swelling, and shortness of breath scores. CONCLUSION The AL-PROfile has acceptable reliability and validity for use in systemic light chain amyloidosis patients.
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Affiliation(s)
- Anita D'Souza
- Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Aniko Szabo
- Division of Biostatistics, Institute of Health & Equity, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Idayat Akinola
- Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Muriel Finkel
- Amyloidosis Support Groups, Inc., Chicago, Illinois, USA
| | - Kathryn E. Flynn
- Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Sikorskii A, Badger T, Segrin C, Crane TE, Cunicelli N, Chalasani P, Arslan W, Given C. Predictors of persistence of post-chemotherapy symptoms among survivors of solid tumor cancers. Qual Life Res 2024; 33:1143-1155. [PMID: 38291312 DOI: 10.1007/s11136-023-03595-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2023] [Indexed: 02/01/2024]
Abstract
CONTEXT Late or residual symptoms diminish quality of life for many cancer survivors after completion of treatment. OBJECTIVES Examine risk factors associated with persisting symptom burden after chemotherapy and the lack of symptom improvement over time. METHODS Survivors who completed curative-intent chemotherapy within two years for solid tumors were enrolled into a symptom management trial. There were 375 survivors with two or more comorbid conditions or one comorbid condition and elevated depressive symptoms (pre-defined risk factors in the trial design) who received interventions and 71 survivors without these risk factors who did not receive interventions. For all survivors, symptoms were assessed at intake, 4, and 13 weeks and categorized as mild, moderate, or severe based on the interference with daily life. The probabilities of moderate or severe symptoms and symptom improvement were analyzed using generalized mixed-effects models in relation to comorbidity, depressive symptoms, age, sex, race/ethnicity, employment, time since chemotherapy completion, and physical function. Multiple symptoms were treated as nested within the survivor. RESULTS Moderate or severe symptoms at baseline and the lack of improvement over time were associated with younger age and lower physical function over and above a greater number of comorbidities and elevated severity of depressive symptoms. CONCLUSION Risk factors identified in this research (younger age, lower physical function, greater comorbidity, and higher depressive symptoms) can be used to allocate resources for post-treatment symptom management for cancer survivors in order to relieve symptoms that do not necessarily resolve with time.
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Affiliation(s)
- Alla Sikorskii
- Department of Psychiatry, College of Osteopathic Medicine, Michigan State University, 909 Wilson Road, Road 321, East Lansing, MI, 48824, USA.
| | - Terry Badger
- College of Nursing, Department of Psychiatry and Mel and Enid Zuckerman College of Public Health, University of Arizona, 1305 N. Martin Avenue, Tucson, AZ, 85721, USA
| | - Chris Segrin
- Department of Communication, University of Arizona, Tucson, USA
| | - Tracy E Crane
- Miller School of Medicine, Division of Medical Oncology, Sylvester Comprehensive Cancer Center, University of Miami, Coral Gables, USA
| | | | - Pavani Chalasani
- Division of Hematology-Oncology, George Washington University, Washington, DC, USA
| | - Waqas Arslan
- College of Medicine, University of Arizona, Phoenix, AZ, USA
| | - Charles Given
- College of Nursing, Michigan State University, East Lansing, USA
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Gambhir T, Al Snih S. Cardiovascular Disease, Depressive Symptoms, and Heart Failure in Mexican American Aged 75 Years and Older During 12 Years of Follow Up. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2024; 16:100724. [PMID: 38689883 PMCID: PMC11060704 DOI: 10.1016/j.jadr.2024.100724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024] Open
Abstract
Objective To examine the relationship of cardiovascular disease (CVD) and high depressive symptoms (HDS) with heart failure (HF) among Mexican American older adults without HF at baseline over 12-years of follow-up. Methods A 12-year prospective cohort study of 1,018 Mexicans Americans aged 75 and older from the Hispanic Established Population for the Epidemiologic Study of the Elderly (2004-2016). Measures included socio-demographics, CVD (heart attack or stroke), HDS, smoking status, body mass index, cognitive function, and HF. Participant were grouped into: CVD and HDS (n=11), CVD only (n=122), HDS only (n=44), and no CVD or HDS (n=841). Odds ratio (OR) and 95% Confidence Interval (CI) of HF over time were estimated using the Generalized Estimating Equation. Results Participants with CVD and HDS and those with HDS only had greater odds (OR=4.70, 95%CI=1.98-11.2 and OR=3.26, 95%CI=1.82-5.84, respectively) of HF over time, after controlling for all covariates. No significant association was found between CVD only and HF (OR=1.25, 95%CI=0.90-1.76). Conclusion Mexican American older adults with HDS only or both HDS and CVD were at high risk of HF. Appropriate management of CVD and depressive symptoms may reduce the onset of HF among this population.
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Affiliation(s)
- Tanishk Gambhir
- John Sealy School of Medicine. The University of Texas Medical Branch, Galveston, TX, USA
| | - Soham Al Snih
- Department of Population Health and Health Disparities/School of Public and Population Health. The University of Texas Medical Branch, Galveston, TX, USA
- Division of Geriatrics and Palliative Medicine/Department of Internal Medicine. The University of Texas Medical Branch, Galveston, TX, USA
- Sealy Center on Aging. The University of Texas Medical Branch, Galveston, TX, USA
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Smith S, Lally P, Steptoe A, Chavez-Ugalde Y, Beeken RJ, Fisher A. Prevalence of loneliness and associations with health behaviours and body mass index in 5835 people living with and beyond cancer: a cross-sectional study. BMC Public Health 2024; 24:635. [PMID: 38419011 PMCID: PMC10903019 DOI: 10.1186/s12889-024-17797-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 01/17/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND A cancer diagnosis and its treatment may be an especially isolating experience. Despite evidence that positive health behaviours can improve outcomes for people living with and beyond cancer (LWBC), no studies have examined associations between loneliness and different health behaviours in this population. This study aimed to describe the prevalence of loneliness in a large sample of UK adults LWBC and to explore whether loneliness was associated with multiple health behaviours. METHODS Participants were adults (aged ≥ 18 years) diagnosed with breast, prostate or colorectal cancer who completed the Health and Lifestyle After Cancer Survey. Loneliness was reported using the UCLA loneliness score, dichotomised into higher (≥ 6) versus lower (< 6) loneliness. Engagement in moderate-to-vigorous physical activity, dietary intake, smoking status, alcohol use, and self-reported height and weight were recorded. Behaviours were coded to reflect meeting or not meeting the World Cancer Research Fund recommendations for people LWBC. Logistic regression analyses explored associations between loneliness and health behaviours. Covariates were age, sex, ethnicity, education, marital status, living situation, cancer type, spread and treatment, time since treatment, time since diagnosis and number of comorbid conditions. Multiple imputation was used to account for missing data. RESULTS 5835 participants, mean age 67.4 (standard deviation = 11.8) years, completed the survey. 56% were female (n = 3266) and 44% (n = 2553) male, and 48% (n = 2786) were living with or beyond breast cancer, 32% (n = 1839) prostate, and 21% (n = 1210) colorectal. Of 5485 who completed the loneliness scale, 81% (n = 4423) of participants reported lower and 19% (n = 1035) higher loneliness. After adjustment for confounders, those reporting higher levels of loneliness had lower odds of meeting the WCRF recommendations for moderate-to-vigorous physical activity (Odds Ratio [OR] 0.78, 95% Confidence Internal [CI], 0.67, 0.97, p =.028), fruit and vegetable intake (OR 0.81, CI 0.67, 1.00, p =.046), and smoking (OR 0.62, 0.46, 0.84, p =.003). No association was observed between loneliness and the other dietary behaviours, alcohol, or body mass index. CONCLUSIONS Loneliness is relatively common in people LWBC and may represent an unmet need. People LWBC who experience higher levels of loneliness may need additional support to improve their health behaviours.
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Affiliation(s)
- Susan Smith
- Department of Behavioural Science and Health, University College London, Gower Street, WC1E 6BT, London, UK
| | - Phillippa Lally
- Department of Psychological Sciences, University of Surrey, GU2 7XH, Guildford, Surrey, UK
| | - Andrew Steptoe
- Department of Behavioural Science and Health, University College London, Gower Street, WC1E 6BT, London, UK
| | - Yanaina Chavez-Ugalde
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, CB2 0QQ, Cambridge, Box 285, UK
| | - Rebecca J Beeken
- Leeds Institute of Health Sciences, University of Leeds, LS2 9JT, Leeds, UK
| | - Abi Fisher
- Department of Behavioural Science and Health, University College London, Gower Street, WC1E 6BT, London, UK.
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Bonhof CS, Mols F, Widdershoven JW, Schoormans D. Colorectal cancer and cardiovascular disease: double the burden when it comes to your health-related quality of life? Acta Oncol 2023; 62:737-743. [PMID: 37609784 DOI: 10.1080/0284186x.2023.2245131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 06/28/2023] [Indexed: 08/24/2023]
Abstract
BACKGROUND The prevalence of comorbid cardiovascular disease (CVD) among patients with colorectal cancer (CRC) has increased in the last decades. Previous studies have focused on the impact of comorbid CVD on clinical outcomes in CRC, while its impact on patients' health-related quality of life (HRQoL) is understudied. This study, therefore, relates (new-onset) CVD to HRQoL (i.e., physical, role, cognitive, emotional, and social functioning, and two CVD-related symptom scales fatigue and dyspnea) in a two-year follow-up study among CRC patients. MATERIALS AND METHODS Newly diagnosed CRC patients from four Dutch hospitals were eligible for participation. Patients (N = 327) completed questions on HRQoL (EORTC QLQ-C30) and the presence and timing of CVDs before initial treatment (baseline) and one and two years after diagnosis. RESULTS CRC patients with comorbid CVD at cancer diagnosis (n = 72, 22%) reported significantly worse physical functioning at 2-year follow-up compared with patients who never had comorbid CVD (p < .05). CRC patients with new-onset CVD (n = 36, 11%) reported worse global QoL, worse role functioning, and more fatigue at 1 and 2-year follow-up compared with patients who never had comorbid CVD. In addition, they reported more dyspnea at baseline and worse physical functioning at 2-year follow-up (p < .05). Finally, patients with new-onset CVD reported worse global quality of life at 1-year follow-up and worse role functioning and more fatigue at 2-year follow-up, compared with patients with comorbid CVD at cancer diagnosis (p < .05). All significant differences between the three groups were of clinical relevance. CONCLUSIONS CRC patients with CVD, specifically those with new-onset CVD, reported a significantly and clinically relevant worse HRQoL compared with those who never had comorbid CVD. These findings seem to indicate, although the number is small, that CRC patients might have cardiovascular needs that need to be addressed and that multidisciplinary care is recommended. Larger studies are needed to confirm this.
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Affiliation(s)
- Cynthia S Bonhof
- CoRPS - Center of Research on Psychological disorders and Somatic diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
- Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Floortje Mols
- CoRPS - Center of Research on Psychological disorders and Somatic diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
- Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Jos W Widdershoven
- CoRPS - Center of Research on Psychological disorders and Somatic diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
- Department of Cardiology, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - Dounya Schoormans
- CoRPS - Center of Research on Psychological disorders and Somatic diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
- Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
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Metabolic Syndrome and Prostate Cancer Risk in Mexican Men: A Population Case-control Study. Arch Med Res 2022; 53:594-602. [DOI: 10.1016/j.arcmed.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 07/06/2022] [Accepted: 07/15/2022] [Indexed: 11/20/2022]
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Jiang C, Deng L, Karr M, Wen Y, Wang Q, Perimbeti S, Shapiro CL, Han X. Chronic comorbid conditions among adult cancer survivors in the United States: Results from the National Health Interview Survey, 2002-2018. Cancer 2022; 128:828-838. [PMID: 34706057 PMCID: PMC8792209 DOI: 10.1002/cncr.33981] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 09/28/2021] [Accepted: 09/30/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND Cancer survivors develop other chronic medical conditions because of shared risk factors and delayed effects of cancer treatment. This study investigated trends in the prevalence of chronic diseases and estimated their population sizes among adult cancer survivors in the United States from 2002 to 2018. METHODS Using 2002-2018 National Health Interview Survey data, this study calculated the age-sex-race/ethnicity-adjusted prevalences and estimated the population sizes for the following chronic conditions among cancer survivors: hypertension, diabetes, stroke, heart disease, chronic obstructive pulmonary disease (COPD)/asthma, hepatitis, arthritis, liver disease, kidney disease, and morbid obesity. This study also examined multiple chronic conditions (MCC; 3 or more health conditions). MCC trends were further examined by sociodemographic factors to identify high-risk populations. Parallel analyses were performed for participants without a cancer history to provide a reference. RESULTS Among 30,728 cancers survivors, increasing trends were observed in the prevalence of hypertension, diabetes, kidney disease, liver disease, and morbid obesity, whereas decreasing prevalence trends were observed for ischemic heart disease, COPD, and hepatitis. Cancer survivors with MCC increased from 4.7 million in 2002 to 8.1 million in 2018 (the prevalence increased from 43.7% to 46.6%). The increase was more pronounced among survivors aged 18 to 44 years. Among adults without a cancer history, the MCC prevalence also increased, although more slowly than among survivors. CONCLUSIONS The number of adult cancer survivors in the United States with comorbid illnesses has increased substantially over the past 2 decades. Optimal management of comorbid conditions and aggressive interventions for risk reduction may benefit the cancer survivor population.
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Affiliation(s)
- Changchuan Jiang
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Lei Deng
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Matthew Karr
- Department of Medicine, Mount Sinai Morningside/Mount Sinai West, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Yumeng Wen
- Division of Nephrology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Qian Wang
- Division of Hematology and Medical Oncology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Stuthi Perimbeti
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Charles L. Shapiro
- Division of Hematology and Medical Oncology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Xuesong Han
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA, USA
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Maeda D, Matsue Y, Kagiyama N, Jujo K, Saito K, Kamiya K, Saito H, Ogasahara Y, Maekawa E, Konishi M, Kitai T, Iwata K, Wada H, Hiki M, Dotare T, Sunayama T, Kasai T, Nagamatsu H, Ozawa T, Izawa K, Yamamoto S, Aizawa N, Yonezawa R, Oka K, Momomura SI, Minamino T. Inaccurate recognition of own comorbidities is associated with poor prognosis in elderly patients with heart failure. ESC Heart Fail 2022; 9:1351-1359. [PMID: 35088546 PMCID: PMC8934983 DOI: 10.1002/ehf2.13824] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 11/30/2021] [Accepted: 01/14/2022] [Indexed: 12/29/2022] Open
Abstract
Aims A patient's understanding of his or her own comorbidities is part of the recommended patient education for those with heart failure. The accuracy of patients' understanding of their comorbidities and its prognostic impact have not been reported. Methods and results Patients hospitalized for heart failure (n = 1234) aged ≥65 years (mean age: 80.1 ± 7.7 years; 531 females) completed a questionnaire regarding their diagnoses of diabetes, malignancy, stroke, hypertension, chronic obstructive pulmonary disease (COPD), and coronary artery disease (CAD). The patients were categorized into three groups based on the number of agreements between self‐reported comorbidities and provider‐reported comorbidities: low (1–2, n = 19); fair (3–4, n = 376); and high (5–6, n = 839) agreement groups. The primary outcome was a composite of all‐cause mortality or heart failure rehospitalization at 1 year. The low agreement group had more comorbidities and a higher prevalence of a history of heart failure. The agreement was good for diabetes (κ = 0.73), moderate for malignancy (κ = 0.56) and stroke (κ = 0.50), and poor‐to‐fair for hypertension (κ = 0.33), COPD (κ = 0.25), and CAD (κ = 0.30). The fair and low agreement groups had poorer outcomes than the good agreement group [fair agreement group: hazard ratio (HR): 1.25; 95% confidence interval (CI): 1.01–1.56; P = 0.041; low agreement group: HR: 2.74: 95% CI: 1.40–5.35; P = 0.003]. Conclusions The ability to recognize their own comorbidities among older patients with heart failure was low. Patients with less accurate recognition of their comorbidities may be at higher risk for a composite of all‐cause mortality or heart failure rehospitalization.
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Affiliation(s)
- Daichi Maeda
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.,Department of Cardiology, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Yuya Matsue
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.,Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Nobuyuki Kagiyama
- Department of Cardiology, The Sakakibara Heart Institute of Okayama, Okayama, Japan.,Department of Digital Health and Telemedicine R&D, Juntendo University, Tokyo, Japan.,Department of Cardiovascular Biology and Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Kentaro Jujo
- Department of Cardiology, Nishiarai Heart Center Hospital, Tokyo, Japan
| | - Kazuya Saito
- Department of Rehabilitation, The Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Kentaro Kamiya
- Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Sagamihara, Japan
| | - Hiroshi Saito
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.,Department of Rehabilitation, Kameda Medical Center, Kamogawa, Japan
| | - Yuki Ogasahara
- Department of Nursing, The Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Emi Maekawa
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Masaaki Konishi
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Takeshi Kitai
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan.,Department of Rehabilitation, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Kentaro Iwata
- Department of Rehabilitation, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Hiroshi Wada
- Department of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Masaru Hiki
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Taishi Dotare
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Tsutomu Sunayama
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Takatoshi Kasai
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.,Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hirofumi Nagamatsu
- Department of Cardiology, Tokai University School of Medicine, Isehara, Japan
| | - Tetsuya Ozawa
- Department of Rehabilitation, Odawara Municipal Hospital, Odawara, Japan
| | - Katsuya Izawa
- Department of Rehabilitation, Kasukabe Chuo General Hospital, Kasukabe, Japan
| | - Shuhei Yamamoto
- Department of Rehabilitation, Shinshu University Hospital, Matsumoto, Japan
| | - Naoki Aizawa
- Department of Cardiovascular Medicine, Nephrology and Neurology, University of the Ryukyus, Okinawa, Japan
| | - Ryusuke Yonezawa
- Rehabilitation Center, Kitasato University Medical Center, Kitamoto, Japan
| | - Kazuhiro Oka
- Department of Rehabilitation, Saitama Citizens Medical Center, Saitama, Japan
| | | | - Tohru Minamino
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.,Japan Agency for Medical Research and Development-Core Research for Evolutionary Medical Science and Technology (AMED-CREST), Japan Agency for Medical Research and Development, Tokyo, Japan
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12
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Liu H, Zhang X, Chen B, Fang B, Lou VWQ, Hu J. The Differential Impact of Multimorbidity Patterns and Subsequent Accumulation on Longitudinal Trajectories of Physical Function Decline in a Population-based Cohort of Older People. J Gerontol A Biol Sci Med Sci 2021; 77:1629-1636. [PMID: 34951651 DOI: 10.1093/gerona/glab384] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Although both the patterns and accumulation of multimorbidity are important for predicting physical function, studies have not simultaneously examined their impact on functional decline. This study aimed to associate multimorbidity patterns and subsequently developed conditions with longitudinal trajectories of functional decline, and it tested whether the effects of newly developed conditions on functional decline varied across distinct multimorbidity patterns. METHODS We included 6,634 participants aged at least 60 years from the China Health and Retirement Longitudinal Survey. Latent class analysis identified multimorbidity patterns from 14 chronic conditions. Mixed negative binomial models estimated the changes in physical function measured across four waves as a function of multimorbidity patterns, subsequently developed conditions and their interactions. RESULTS Five distinct patterns were identified three years before wave 1: stomach/arthritis (15.7%), cardiometabolic (6.7%), arthritis/hypertension (47.9%), hepatorenal/multi-system (18.3%), and lung/asthma (11.4%). The hepatorenal/multi-system and the lung/asthma pattern were associated with worse baseline physical function, and the hypertension/arthritis pattern was associated with greater decline of physical function. The effect of developing new conditions on decline of physical function over time was most evident for individuals from the cardiometabolic pattern. DISCUSSION Considering both the combinations and progressive nature of multimorbidity is important for identifying individuals at greater risk of disability. Future studies are warranted to differentiate the factors responsible for the progression of chronic conditions in distinct multimorbidity patterns and investigate the potential implications for improved prediction of functional decline.
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Affiliation(s)
- Huiying Liu
- Department of Sociology, Central South University, Changsha, Hunan province, China.,Sau Po Centre on Ageing, University of Hong Kong, Hong Kong, China
| | - Xinyan Zhang
- Department of Sociology, Central South University, Changsha, Hunan province, China
| | - Beizhuo Chen
- Department of Sociology, Central South University, Changsha, Hunan province, China
| | - Boye Fang
- Sun Yat-Sen University, School of Sociology & Anthropology, Guangzhou, Guangdong province, CN
| | - Vivian W Q Lou
- Sau Po Centre on Ageing, University of Hong Kong, Hong Kong, China.,Department of Social Work and Social Administration, University of Hong Kong, Hong Kong, China
| | - Jian Hu
- Department of Hematology, Xiangya Hospital, Central South University, Changsha, Hunan province, China
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13
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Serper M, Evon DM, Amador J, Stewart PW, Sarkar S, Lok AS, Sterling RK, Reeve BB, Golin CE, Reddy KR, Lim JK, Reau N, Nelson DR, Di Bisceglie AM, Fried MW. Patient-reported outcomes 12 months after hepatitis C treatment with direct-acting antivirals: Results from the PROP UP study. Liver Int 2021; 41:692-704. [PMID: 33387381 PMCID: PMC7969418 DOI: 10.1111/liv.14781] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 12/06/2020] [Accepted: 12/28/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND & AIMS The long-term impact of hepatitis C virus (HCV) therapy with all-oral direct-acting antivirals (DAAs) on patient-reported outcomes (PROs) has not been well-described. We characterized changes in PROs from pre-treatment to 12 months post-treatment in a real-world cohort. METHODS PROP UP was a multi-centre observational cohort study of 1601 patients treated with DAAs at 11 US gastroenterology/hepatology practices from 2015 to 2017. PROs were evaluated pre-treatment (T1) and 12 months post-treatment (T5). A minimally important change (MIC) threshold was prespecified as >5% change in PRO scores from T1 to T5. Multivariable analyses identified predictors of change. RESULTS Three-quarters of patients were 55 or older; 45% were female, 60% were white, 33% were black, nearly half had cirrhosis. The most commonly-prescribed DAA regimens were sofosbuvir-based (83%) and grazoprevir/elbasvir (11%). Study retention was >95%. On average, small improvements were observed at 3 months post-treatment in all PROs and sustained at 12 months post-treatment among patients with sustained virologic response (SVR). Clinically meaningful improvements were achieved in fatigue (mean change score: -3.7 [-4.2, -3.1]), sleep (mean change score: -3.1 [-3.7, -2.5]), abdominal pain (mean change score: -2.6 [-3.3, -1.9]) and functional well-being (mean change score: -7.0 [-6.0, -8.0]). Symptom improvements were generally not sustained with no SVR (n = 52). Patients with cirrhosis and MELD ≥12 had the greatest improvements in functional well-being (-12.9 [-17.6, -8.1]). CONCLUSIONS The improvements in patient-reported outcomes reported by patients who achieved SVR following HCV DAA therapy were durable at 12 months post-treatment.
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Affiliation(s)
- Marina Serper
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Donna M. Evon
- Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina, Chapel Hill, NC, United States
| | - Jipcy Amador
- Department of Biostatistics, University of North Carolina, Chapel Hill, NC, United States
| | - Paul W. Stewart
- Department of Biostatistics, University of North Carolina, Chapel Hill, NC, United States
| | - Souvik Sarkar
- Division of Gastroenterology and Hepatology, Department of Medicine, University of California at Davis, Davis, CA, United States
| | - Anna S. Lok
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Richard K. Sterling
- Division of Gastroenterology, Hepatology & Nutrition, Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, United States
| | - Bryce B. Reeve
- Department of Population Health Sciences, Duke University, Durham, NC, United States
| | - Carol E. Golin
- Division of General Medicine and Clinical Epidemiology, Department of Medicine, Department of Health Behaviors, University of North Carolina, Chapel Hill, NC, United States
| | - K. Rajender Reddy
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Joseph K. Lim
- Digestive Diseases, Department of Internal Medicine, Yale University, New Haven, CT, United States
| | - Nancy Reau
- Department of Internal Medicine, Section of Hepatology, Rush University, Chicago, IL, United States
| | - David R. Nelson
- Division of Gastroenterology, Hepatology & Nutrition, Department of Medicine, University of Florida, Gainesville, FL, United States
| | - Adrian M. Di Bisceglie
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Saint Louis University, St. Louis, MO, United States
| | - Michael W. Fried
- Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina, Chapel Hill, NC, United States
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14
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Möhl A, Orban E, Jung AY, Behrens S, Obi N, Chang-Claude J, Becher H. Comorbidity burden in long-term breast cancer survivors compared with a cohort of population-based controls from the MARIE study. Cancer 2020; 127:1154-1160. [PMID: 33259052 DOI: 10.1002/cncr.33363] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 09/21/2020] [Accepted: 11/13/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND The number of elderly cancer survivors is growing because of increasing survival rates. A high comorbidity burden in the elderly can affect their quality of life and survival. The aim of this study was to examine whether breast cancer survivors and population-based controls have a different comorbidity burden after long-term follow-up. METHODS This study used data from a German breast cancer case-control study, which initially comprised 3813 breast cancer cases aged 50 to 74 years who were diagnosed between 2002 and 2005 and 7341 population-based controls. Participants were followed up in 2014/2016. A modified Charlson Comorbidity Index (mCCI) was calculated to quantify severe comorbidities. Negative binomial regression was performed to estimate rate ratios (RRs) with 95% confidence intervals (CIs) for the association between case-control status and mCCI (dependent variable) for the baseline population and for those who participated at follow-up, with adjustments made for relevant lifestyle factors. RESULTS In total, 1925 cases and 3674 controls participated in the follow-up 12 years after recruitment. In the baseline population 35% had at least 1 comorbid condition.In long-term survivors this proportion was 52%. No difference was found in the mCCI between breast cancer cases and controls at baseline (RR, 1.05; 95% CI, 0.98-1.11) or between long-term survivors of the 2 groups at baseline (RR, 1.07; 95% CI, 0.97-1.18) or at follow-up (RR, 1.00; 95% CI, 0.91-1.10). CONCLUSIONS The comorbidity burden of long-term breast cancer survivors and controls increased over time; however, it remained similar in both groups after 12 years of follow-up.
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Affiliation(s)
- Annika Möhl
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ester Orban
- Cancer Epidemiology Group, University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Audrey Y Jung
- Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany
| | - Sabine Behrens
- Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany
| | - Nadia Obi
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jenny Chang-Claude
- Cancer Epidemiology Group, University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany
| | - Heiko Becher
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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15
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Papaleontiou M, Evron JM, Esfandiari NH, Reyes-Gastelum D, Ward KC, Hamilton AS, Worden F, Haymart MR. Patient Report of Recurrent and Persistent Thyroid Cancer. Thyroid 2020; 30:1297-1305. [PMID: 32183609 PMCID: PMC7482108 DOI: 10.1089/thy.2019.0652] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background: Despite the excellent survival of most patients with differentiated thyroid cancer (DTC), recurrent and persistent disease remain major concerns for physicians and patients. However, studies on patient report of recurrent and persistent disease are lacking. Methods: Between February 1, 2017, and October 31, 2018, we surveyed eligible patients who were diagnosed with DTC between 2014 and 2015 from the Georgia and Los Angeles Surveillance, Epidemiology, and End Results cancer registries (N = 2632; response rate, 63%). Patients who reported current disease status were included in this study (n = 2454). Patient-reported data were linked to registry data. A multivariable, multinomial logistic regression analysis was conducted to determine patient and tumor characteristics associated with recurrent and persistent thyroid cancer. Quality of life was evaluated using the Patient-Reported Outcomes Measurement Information System-Global Health v1.2 questionnaire. Meaningful change in global health was defined as a minimal difference of a half standard deviation or 5 points compared with the mean (T score = 50) of a sample population matching the United States 2000 General Census. Results: Of the 2454 patients completing the survey, 95 (4.1%) reported recurrent disease and 137 (5.8%) reported persistent disease. In multinomial analyses, T3/T4 classification and cervical lymph node involvement (N1) were associated with both report of recurrent (adjusted relative risk ratio [RRR] 1.99, 95% confidence interval [CI 1.16-3.42]; adjusted RRR 2.03 [CI 1.29-3.21], respectively) and persistent disease (adjusted RRR 3.48 [CI 1.96-6.20]; adjusted RRR 3.56 [CI 2.41-5.24], respectively). Additionally, Hispanic ethnicity was associated with report of recurrent disease (adjusted RRR 1.99 [CI 1.23-3.24]). Regarding quality of life, the median scores in patients with persistent disease met criteria for meaningful change in global physical health (T-score = 44.9) and global mental health (T-score = 43.5) when compared with the general population norms. Median scores in patients with cured or recurrent disease did not meet criteria for meaningful change. Conclusions: Patient report is a reasonable method of assessing recurrent and persistent disease. Impact on quality of life is more marked for patients with reported persistent disease. Our findings will help personalize treatment and long-term follow-up in these patients.
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Affiliation(s)
- Maria Papaleontiou
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Josh M. Evron
- Division of Endocrinology and Metabolism, Department of Internal Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Nazanene H. Esfandiari
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - David Reyes-Gastelum
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Kevin C. Ward
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Ann S. Hamilton
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Francis Worden
- Division of Hematology and Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Megan R. Haymart
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
- Address correspondence to: Megan R. Haymart, MD, Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, North Campus Research Complex, 2800 Plymouth Road, Building 16, Room 408E, Ann Arbor, MI 48109
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16
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Improving identification of candidates for lung cancer screening in a high risk population. Lung Cancer 2020; 148:79-85. [PMID: 32827761 DOI: 10.1016/j.lungcan.2020.07.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 07/28/2020] [Accepted: 07/30/2020] [Indexed: 01/23/2023]
Abstract
BACKGROUND Low dose computerized tomography (LDCT) has been shown to reduce lung cancer specific mortality by 20 %. Despite U.S. Preventive Services Task Force (USPSTF) endorsement, screening of appropriate patients in the U.S. remains low, at 1.9 %. The goal of this study was to assess the number and type of patients that would qualify for lung cancer screening based upon recommendations by various guidelines. METHODS We prospectively collected a patient reported questionnaire, including smoking history, family history, exposure history, and demographics, from April-October 2017 from new consults in the Department of Radiation Oncology and Otolaryngology (ORL). Patients smoking status and patient factors were collected and reported. Patients qualifying for screening by USPSTF, the National Comprehensive Cancer Network (NCCN), and Tammemagi scoring criteria were identified. Multivariate analysis assessed the factors associated with positive criteria for screening and the sensitivity of each criterion was calculated. RESULTS There were 546 new consults during the study period and 528 successfully completed the questionnaire. A total of 104/528 (20 %) patients who completed questionnaires qualified for screening based on any guideline. After exclusion of active lung cancer (n = 19), poor prognosis (n = 24), and CT as part of surveillance (n = 16), 45 (8.5 %) patients would require LDCT. Of the entire population, 10 %, 11 % and 18 % of patients qualified based on USPSTF, NCCN, and Tammemagi, which was reduced to 4.9 %, 5.3 %, and 7.8 %, respectively after exclusions. Patients with head and neck cancer (40 %), skin cancer (27 %), and prostate cancer (11 %) accounted for the majority of patients eligible for screening after exclusions. The sensitivity of the USPSTF, NCCN, and Tammemagi criteria in patients with a diagnosis of lung cancer (n = 26) was 38.5 % (CI95 20.2 %-59.4 %), 46.2 % (CI95 26.6 %-66.6 %), and 61.5 % (CI95 40.6 %-79.8 %), respectively. CONCLUSIONS We successfully identified 9 % of an oncology population at consultation who could benefit from lung cancer screening in survivorship. Distribution of a written or electronic questionnaire at consultation is a simple, low cost, effective method of identifying patients who would benefit from LDCT.
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17
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Mueller-Schotte S, Zuithoff NPA, Van der Schouw YT, Schuurmans MJ, Bleijenberg N. Trends in Risk of Limitations in Instrumental Activities of Daily Living Over Age in Older Persons With and Without Multiple Chronic Conditions. J Gerontol A Biol Sci Med Sci 2020; 75:197-203. [PMID: 30772903 PMCID: PMC6909894 DOI: 10.1093/gerona/glz049] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Indexed: 01/09/2023] Open
Abstract
Background To investigate trends over age by comorbidity status for the risk of limitations in individual activities of daily living for community-living older persons. Methods A longitudinal population-based study was conducted in 9,319 community-living Dutch persons aged 60 years and older. Self-reported multiple chronic conditions (MCC) and nine instrumental activities of daily livings (IADLs) were assessed in 15 studies of the Dutch National Care for the Elderly Program (TOPICS-MDS). Risks of limitations in IADLs, odds ratios (per 5 years), and rate ratios (per 5 years) were calculated with mixed logistic and negative binomial regression models with age as the underlying timescale, stratified by number of MCC (no, 1–2, ≥ 3 MCC), and corrected for confounders. Results At inclusion, the number of IADL limitations was highest for the “≥3 MCC” group (2.00 interquartile range [1.00–4.00]) and equal for “no MCC” or “1–2 MCC” (1.00 interquartile range [0.00–2.00]). Trends of individual IADLs depicted a higher risk in IADL limitation with increasing age over 2 years of follow-up, except for handling finances for the “no MCC” group. The longitudinal age effect on IADL limitations varied subject to MCC, being strongest for the “no MCC” group for most IADLs; grooming and telephone use were almost unaltered by age and MCC. Conclusion We observed a decline in IADL functioning with increasing age over 2 years of follow-up in persons with and without MCC. The impact of MCC on IADL decline varied per IADL activity.
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Affiliation(s)
- Sigrid Mueller-Schotte
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht (UMC Utrecht).,Department for the Chronically Ill, University of Applied Sciences Utrecht, The Netherlands.,Department of Optometry and Orthoptics, University of Applied Sciences Utrecht, The Netherlands
| | - Nicolaas P A Zuithoff
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht (UMC Utrecht)
| | - Yvonne T Van der Schouw
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht (UMC Utrecht)
| | - Marieke J Schuurmans
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht (UMC Utrecht).,Department for the Chronically Ill, University of Applied Sciences Utrecht, The Netherlands
| | - Nienke Bleijenberg
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht (UMC Utrecht).,Department for the Chronically Ill, University of Applied Sciences Utrecht, The Netherlands
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18
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Bennett AV, Jonsson M, Chen RC, Al-Khatib SM, Weinfurt KP, Curtis LH. Applying patient-reported outcome methodology to capture patient-reported health data: Report from an NIH Collaboratory roundtable. HEALTHCARE-THE JOURNAL OF DELIVERY SCIENCE AND INNOVATION 2020; 8:100442. [PMID: 32919581 DOI: 10.1016/j.hjdsi.2020.100442] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 05/31/2020] [Indexed: 11/28/2022]
Abstract
Patient-reported health data provide information for pragmatic clinical trials that may not be readily available from electronic health records or administrative claims data. In this report, we present key considerations for collecting patient-reported health information in pragmatic clinical trials, which are informed by best practices from patient-reported outcome research. We focus on question design and administration via electronic data collection platforms with respect to 3 types of patient-reported health data: medication use, utilization of health care services, and comorbid conditions. We summarize key scientific literature on the accuracy of these patient-reported data compared with electronic health record data. We discuss question design in detail, specifically defining the concept to be measured, patient understanding of the concept, recall periods of the question, and patient willingness to report. In addition, we discuss approaches for question administration and data collection platforms, which are key aspects of successful patient-reported data collection.
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Affiliation(s)
- Antonia V Bennett
- Department of Health Policy and Management, UNC Gillings School of Global Public Health, USA; Patient-Reported Outcomes Core, Cancer Outcomes Research Program, Lineberger Comprehensive Cancer Center, USA
| | - Mattias Jonsson
- Patient-Reported Outcomes Core, Cancer Outcomes Research Program, Lineberger Comprehensive Cancer Center, USA
| | - Ronald C Chen
- Department of Radiation Oncology, UNC School of Medicine, USA
| | - Sana M Al-Khatib
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Duke Clinical Research Institute, USA; Departments of Medicine, USA
| | - Kevin P Weinfurt
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Duke Clinical Research Institute, USA; Population Health Sciences, USA
| | - Lesley H Curtis
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Duke Clinical Research Institute, USA; Population Health Sciences, USA; Duke University School of Medicine, Durham, NC, USA.
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19
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Jefferson M, Drake RR, Lilly M, Savage SJ, Tucker Price S, Hughes Halbert C. Co-morbidities in a Retrospective Cohort of Prostate Cancer Patients. Ethn Dis 2020; 30:185-192. [PMID: 32269460 DOI: 10.18865/ed.30.s1.185] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective To characterize rates of co-morbidity among prostate cancer patients treated with radical prostatectomy and to examine the association between co-morbidity status and race, clinical factors, and health behaviors for cancer control. Design/Study Participants Retrospective cohort study among prostate cancer patients treated with radical prostatectomy. Setting Academic medical center located in the southeastern region of the United States. Main Outcome Measure Patients with at least one of five co-morbid conditions considered were categorized as having a co-morbidity, and those without any were categorized as not having a co-morbid condition. Co-morbid conditions considered were hypertension, diabetes, heart problems, stroke, and high cholesterol, which had been recorded in the electronic medical record as part of their past medical history. Results Fifty-one percent of participants had a co-morbidity, with hypertension being the most common. The average number of co-morbidities among study participants was .87. In a multivariate logistic regression analysis, being diagnosed with prostate cancer within the past four years was associated with an increased likelihood of having a co-morbidity (OR=4.71, 95% CI=2.69, 8.25, P=.0001) compared with diagnosis five or more years ago. Age was also associated with an increased likelihood of having a co-morbidity (OR=1.30, 95% CI=1.005, 1.68, P=.05). In this study cohort, race, stage at diagnosis, and PSA level were not statistically associated with co-morbidity status. Conclusion Better chronic disease management is needed among prostate cancer survivors through more effective survivorship care planning and interventions that promote health behaviors.
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Affiliation(s)
- Melanie Jefferson
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC.,Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
| | - Richard R Drake
- Department of Cell and Molecular Pharmacology and Experimental Therapeutics, Medical University of South Carolina, Charleston, SC.,Hollings Cancer Center, Medical University of South Carolina, Charleston, SC
| | - Michael Lilly
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC.,Department of Medicine, Medical University of South Carolina, Charleston, SC
| | - Stephen J Savage
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC.,Department of Urology, Medical University of South Carolina, Charleston, SC
| | - Sarah Tucker Price
- Department of Family Medicine, Medical University of South Carolina, Charleston, SC
| | - Chanita Hughes Halbert
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC.,Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
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20
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Malik FS, Stafford JM, Reboussin BA, Klingensmith GJ, Dabelea D, Lawrence JM, Mayer-Davis E, Saydah S, Corathers S, Pihoker C. Receipt of recommended complications and comorbidities screening in youth and young adults with type 1 diabetes: Associations with metabolic status and satisfaction with care. Pediatr Diabetes 2020; 21:349-357. [PMID: 31797506 PMCID: PMC7597528 DOI: 10.1111/pedi.12948] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Revised: 10/26/2019] [Accepted: 11/01/2019] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVES This study sought to: (a) assess the prevalence of diabetes complications and comorbidities screening as recommended by the American Diabetes Association (ADA) for youth and young adults (YYAs) with type 1 diabetes (T1D), (b) examine the association of previously measured metabolic status related to diabetes complications with receipt of recommended clinical screening, and (c) examine the association of satisfaction with diabetes care with receipt of recommended clinical screening. METHODS The study included 2172 SEARCH for Diabetes in Youth participants with T1D (>10 years old, diabetes duration >5 years). Mean participant age was 17.7 ± 4.3 years with a diabetes duration of 8.1 ± 1.9 years. Linear and multinomial regression models were used to evaluate associations. RESULTS Sixty percent of participants reported having three or more hemoglobin A1c (HbA1c) measurements in the past year. In terms of diabetes complications screening, 93% reported having blood pressure measured, 81% having an eye examination, 71% having lipid levels checked, 64% having a foot exam, and 63% completing albuminuria screening in accordance with ADA recommendations. Youth known to have worse glycemic control in the past had higher odds of not meeting HbA1c screening criteria (OR 1.11, 95% CI = 1.05, 1.17); however, after adjusting for race/ethnicity, this was no longer statistically significant. Greater satisfaction with diabetes care was associated with increased odds of meeting screening criteria for most of the ADA-recommended measures. CONCLUSIONS Efforts should be made to improve diabetes complications screening efforts for YYAs with T1D, particularly for those at higher risk for diabetes complications.
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Affiliation(s)
- Faisal S. Malik
- Department of Pediatrics, University of Washington, Seattle, WA
| | - Jeanette M. Stafford
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC
| | - Beth A. Reboussin
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC
| | | | - Dana Dabelea
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO
| | - Jean M. Lawrence
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Elizabeth Mayer-Davis
- Departments of Nutrition and Medicine, University of North Carolina, Chapel Hill, NC
| | - Sharon Saydah
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Georgia
| | - Sarah Corathers
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
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21
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Abdin E, Chong SA, Vaingankar JA, Shafie S, Verma S, Luo N, Tan KB, James L, Heng D, Subramaniam M. Impact of mental disorders and chronic physical conditions on quality-adjusted life years in Singapore. Sci Rep 2020; 10:2695. [PMID: 32060390 PMCID: PMC7021810 DOI: 10.1038/s41598-020-59604-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 01/31/2020] [Indexed: 11/24/2022] Open
Abstract
The current study aims to evaluate the burden of disease in Singapore by estimating the quality-adjusted life years (QALYs) lost due to mental disorders and chronic physical conditions. The second Singapore Mental Health Study (SMHS-2016) was conducted in 2016 among 6126 respondents aged 18 years and above. The World Health Organization Composite International Diagnostic Interview version 3.0 (WHO-CIDI 3.0) and a modified version of the CIDI chronic medical disorders checklist were used to assess the 12-month diagnoses of mental and chronic physical disorders while the SF-6D scores derived from the 12-item Short Form Health Survey instrument was used to estimate the QALYs lost. The mean SF-6D score in this population was 0.87. The largest reduction in SF-6D scores among people with mental disorders was observed in Generalized Anxiety Disorder (GAD), followed by Major Depressive Disorder (MDD), alcohol abuse, bipolar disorder and Obsessive Compulsive Disorder (OCD) while the largest reduction in SF-6D score among people with chronic physical conditions was observed in ulcer, followed by lung disease, chronic pain and cardiovascular disease. At the population level, chronic pain was associated with the greatest QALY loss followed by MDD (14,204 and 6,889 respectively). Lung disease was associated with the smallest QALY loss (376). These findings highlight chronic pain, MDD, OCD, cardiovascular disease and GAD as the five leading contributors of QALYs lost in the general population which deserve prioritisation in public health prevention programmes.
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Affiliation(s)
- Edimansyah Abdin
- Research Division, Institute of Mental Health, Singapore, Singapore.
| | - Siow Ann Chong
- Research Division, Institute of Mental Health, Singapore, Singapore
| | | | - Saleha Shafie
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Swapna Verma
- Early Psychosis Intervention Programme, Institute of Mental health, Singapore, Singapore
| | - Nan Luo
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | | | - Lyn James
- Ministry of Health, Singapore, Singapore
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22
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Fleshner K, Tin A, Benfante N, Carlsson S, Vickers AJ. Comparison of Physician-Documented Versus Patient-Reported Collection of Comorbidities Among Patients With Prostate Cancer Upon First Visit to the Urology Clinic. JCO Clin Cancer Inform 2019; 2:1-10. [PMID: 30652570 DOI: 10.1200/cci.17.00154] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To determine whether patient-reported collection of comorbidities online is sufficiently accurate to warrant use as part of a physician-reviewed, baseline medical history. METHODS Comorbidities were collected for a sample of 213 new prostate cancer visits to our urology clinic through an online survey (called Baseline Medical History) before the clinical encounter. The frequency distributions of comorbidities as reported by patients before physician review were compared with those documented by physicians for a sample of 298 consecutive patients presenting to the same urology clinic before the survey went live. RESULTS The overall frequency distribution of comorbidities and life expectancy estimates were similar between the two groups. A few comorbidity categories were reported with higher frequency in the patient-reported group compared with the physician-documented group, including neurologic comorbidities (7.5% v 1.7%; difference 6%; 95% CI, 2.0% to 10%; P = .001) and back pain (24% v 13%; difference 12%; 95% CI, 4.8% to 19%; P = .001). A similar trend was seen for vascular conditions, although the difference did not meet conventional levels of statistical significance. Genitourinary comorbidities, including problems with urination and erectile dysfunction, were better captured by the physician-reported group compared with the patient-reported group (68% v 53%; difference 15%; 95% CI, 7% to 24%; P = .001), as were other musculoskeletal comorbidities (8.7% v 1.9%; difference 7%; 95% CI, 3.2% to 11%; P = .001). CONCLUSION Patients completing a medical history, at their own pace and in the comfort of their own home, provide relatively accurate and complete information, even before physician review. Patient reporting of comorbidities thus seems to be a reliable starting point for the documentation of the medical history in the clinic.
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Affiliation(s)
- Katherine Fleshner
- Katherine Fleshner, University of Western Ontario, London, Ontario, Canada; Amy Tin, Nicole Benfante, Sigrid V. Carlsson, and Andrew J. Vickers, Memorial Sloan Kettering Cancer Center, New York, NY; and Sigrid V. Carlsson, Gothenburg University, Gothenburg, Sweden
| | - Amy Tin
- Katherine Fleshner, University of Western Ontario, London, Ontario, Canada; Amy Tin, Nicole Benfante, Sigrid V. Carlsson, and Andrew J. Vickers, Memorial Sloan Kettering Cancer Center, New York, NY; and Sigrid V. Carlsson, Gothenburg University, Gothenburg, Sweden
| | - Nicole Benfante
- Katherine Fleshner, University of Western Ontario, London, Ontario, Canada; Amy Tin, Nicole Benfante, Sigrid V. Carlsson, and Andrew J. Vickers, Memorial Sloan Kettering Cancer Center, New York, NY; and Sigrid V. Carlsson, Gothenburg University, Gothenburg, Sweden
| | - Sigrid Carlsson
- Katherine Fleshner, University of Western Ontario, London, Ontario, Canada; Amy Tin, Nicole Benfante, Sigrid V. Carlsson, and Andrew J. Vickers, Memorial Sloan Kettering Cancer Center, New York, NY; and Sigrid V. Carlsson, Gothenburg University, Gothenburg, Sweden
| | - Andrew J Vickers
- Katherine Fleshner, University of Western Ontario, London, Ontario, Canada; Amy Tin, Nicole Benfante, Sigrid V. Carlsson, and Andrew J. Vickers, Memorial Sloan Kettering Cancer Center, New York, NY; and Sigrid V. Carlsson, Gothenburg University, Gothenburg, Sweden
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23
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Mounier N, Anthony S, Busson R, Thieblemont C, Ribrag V, Tilly H, Haioun C, Casasnovas RO, Morschhauser F, Feugier P, Delarue R, Ysebaert L, Sebban C, Broussais-Guillaumot F, Damaj G, Nerich V, Jais JP, Laborde L, Salles G, Henry-Amar M. Long-term fatigue in survivors of non-Hodgkin lymphoma: The Lymphoma Study Association SIMONAL cross-sectional study. Cancer 2019; 125:2291-2299. [PMID: 30901086 DOI: 10.1002/cncr.32040] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 02/06/2019] [Accepted: 02/06/2019] [Indexed: 11/12/2022]
Abstract
BACKGROUND Long-term survivors of non-Hodgkin lymphoma (NHL) must cope with treatment complications and late toxicities that affect their health-related quality of life. Little is known about the risk-to-benefit ratio of new agents like rituximab. The impact of treatment regimens and health disorders on long-term fatigue levels was investigated in a cross-sectional study. METHODS Two self-administered questionnaires, the 20-item Multidimensional Fatigue Inventory (MFI-20) and a Life Situation Questionnaire, were mailed in 2015 to NHL survivors enrolled onto 12 successive clinical studies (1993-2010) conducted by the Lymphoma Study Association. Private addresses were obtained for 3317 survivors, of whom 1671 (50%) returned the questionnaires. Severe fatigue was defined as MFI-20 scores ≥60 on dimension scales scored from 0 to 100. Linear regression models were used to assess factors that were linked to increased fatigue levels. RESULTS The study population included 906 men and 765 women, and the median age was 64 years (age range, 24-95 years). Overall, 811 survivors had received cyclophosphamide, doxorubicin, vincristine, prednisone (CHOP)-like chemotherapy, 518 had received high-dose CHOP, and 342 had undergone upfront autologous stem cell transplantation; 829 survivors also had received rituximab. In total, 1100 survivors (66%) reported 1 or more late health disorders. Severe fatigue was reported by 602 survivors (37%). Increased fatigue levels were associated (P < .001) with increased age, obesity, and the presence of health disorders, but not with initial treatment or rituximab. CONCLUSIONS The survey confirms that high proportions long-term NHL survivors have severe fatigue. The results suggest that initial treatment and the receipt of rituximab have no influence on the development of long-term fatigue.
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Affiliation(s)
- Nicolas Mounier
- Onco-Hematology Unit, l'Archet Hospital, Nice University Hospital Center, University of Côte d'Azur, Nice, France
| | - Sabine Anthony
- Clinical Research and Innovation Office, Cimiez Hospital, Nice University Hospital Center, University of Côte d'Azur, Nice, France
| | - Raphaël Busson
- Mathematics, Information, and Engineering Systems (MIIS) Doctoral School, Caen-Normandy University, Caen, France.,French Center on eHealth, North-West Region Data Processing Center and French National League Against Cancer Clinical Research Platform, Caen, France
| | - Catherine Thieblemont
- Hemato-Oncology Unit, Saint-Louis University Hospital Center, Public Hospital Network of Paris, Paris, France
| | - Vincent Ribrag
- Hematology Unit, Gustave Roussy Cancer Campus, Villejuif, France
| | - Hervé Tilly
- Hematology Department and French Institute of Health and Medical Research (INSERM) Unit 1243, Henri Becquerel Center, Rouen, France
| | - Corinne Haioun
- Lymphoid Malignancies Unit, Henri Mondor University Hospital Center, Public Hospital Network of Paris, Créteil, France
| | - René-Olivier Casasnovas
- Hematology Unit and French Institute of Health and Medical Research (INSERM) Unit 1231, Bocage Hospital, Dijon Bourgogne Regional University Hospital Center, Dijon, France
| | - Franck Morschhauser
- Hematology Transfusion Institute, Claude Huriez Hospital, Lille Regional University Hospital Center, Lille, France
| | - Pierre Feugier
- Hematology Unit, Brabois Hospital, Nancy University Hospital Center, Vandœuvre-lès-Nancy, France
| | - Richard Delarue
- Hematology Unit, Necker University Hospital for Sick Children, Public Hospital Network of Paris, Paris, France
| | - Loic Ysebaert
- Oncopole, Toulouse University Cancer Institute, Toulouse, France
| | | | | | - Gandhi Damaj
- Basse-Normandy Hematology Institute, Côte de Nacre Regional University Hospital Center, Caen, France
| | - Virginie Nerich
- Regional Federative Institute of Cancerology, Besancon, France
| | - Jean-Philippe Jais
- Laboratory of Biostatistics, Paris V University-Descartes, Paris, France
| | - Lilian Laborde
- Paoli-Calmettes Institute-Provence-Alpes-Côte d'Azur (IPC-PACA) Data Processing Center, Marseille, France
| | - Gilles Salles
- Faculty of Medicine, Claude Bernard University, Lyon, France.,Hematology Department, Lyon South Hospital Center, Pierre-Bénite, France
| | - Michel Henry-Amar
- French Center on eHealth, North-West Region Data Processing Center and French National League Against Cancer Clinical Research Platform, Caen, France
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24
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Lee E, Nelson OL, Puyana C, Takita C, Wright JL, Zhao W, Reis IM, Lin RY, Hlaing WM, Bakalar JL, Yang GR, Hu JJ. Association between C-reactive protein and radiotherapy-related pain in a tri-racial/ethnic population of breast cancer patients: a prospective cohort study. Breast Cancer Res 2019; 21:70. [PMID: 31138314 PMCID: PMC6537305 DOI: 10.1186/s13058-019-1151-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 05/06/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Post-surgery adjuvant radiotherapy (RT) significantly improves clinical outcomes in breast cancer patients; however, some patients develop cancer or treatment-related pain that negatively impacts quality of life. This study examined an inflammatory biomarker, C-reactive protein (CRP), in RT-related pain in breast cancer. METHODS During 2008 and 2014, breast cancer patients who underwent RT were prospectively evaluated for pre- and post-RT pain. Pre- and post-RT plasma CRP levels were measured using a highly sensitive CRP ELISA kit. Pain score was assessed as the mean of four pain severity items (i.e., pain at its worst, least, average, and now) from the Brief Pain Inventory. Pain scores of 4-10 were classified as clinically relevant pain. Multivariable logistic regression analyses were applied to ascertain the associations between CRP and RT-related pain. RESULTS In 366 breast cancer patients (235 Hispanic whites, 73 black/African Americans, and 58 non-Hispanic whites), 17% and 30% of patients reported pre- and post-RT pain, while 23% of patients had RT-related pain. Both pre- and post-RT pain scores differed significantly by race/ethnicity. In multivariable logistic regression analysis, RT-related pain was significantly associated with elevated pre-RT CRP (≥ 10 mg/L) alone (odds ratio (OR) = 2.44; 95% confidence interval (CI) = 1.02, 5.85); or combined with obesity (OR = 4.73; 95% CI = 1.41, 15.81) after adjustment for age and race/ethnicity. CONCLUSIONS This is the first pilot study of CRP in RT-related pain, particularly in obese breast cancer patients. Future larger studies are warranted to validate our findings and help guide RT decision-making processes and targeted interventions.
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Affiliation(s)
- Eunkyung Lee
- Department of Health Sciences, University of Central Florida College of Health Professions and Sciences, Orlando, FL, 32816, USA.
| | - Omar L Nelson
- Department of Public Health Sciences, University of Miami School of Medicine, Miami, FL, 33136, USA
| | - Carolina Puyana
- Department of Public Health Sciences, University of Miami School of Medicine, Miami, FL, 33136, USA
| | - Cristiane Takita
- Department of Radiation Oncology, University of Miami School of Medicine, Miami, FL, USA
| | - Jean L Wright
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Wei Zhao
- Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, Miami, FL, USA
| | - Isildinha M Reis
- Department of Public Health Sciences, University of Miami School of Medicine, Miami, FL, 33136, USA
- Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, Miami, FL, USA
| | - Rick Y Lin
- Department of Public Health Sciences, University of Miami School of Medicine, Miami, FL, 33136, USA
| | - WayWay M Hlaing
- Department of Public Health Sciences, University of Miami School of Medicine, Miami, FL, 33136, USA
| | - Johnna L Bakalar
- Department of Public Health Sciences, University of Miami School of Medicine, Miami, FL, 33136, USA
| | - George R Yang
- Department of Public Health Sciences, University of Miami School of Medicine, Miami, FL, 33136, USA
| | - Jennifer J Hu
- Department of Public Health Sciences, University of Miami School of Medicine, Miami, FL, 33136, USA.
- Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, Miami, FL, USA.
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25
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Wright P, Wilding S, Watson E, Downing A, Selby P, Hounsome L, Wagland R, Brewster DH, Huws D, Butcher H, Mottram R, Kearney T, Allen M, Gavin A, Glaser A. Key factors associated with social distress after prostate cancer: Results from the United Kingdom Life after Prostate Cancer diagnosis study. Cancer Epidemiol 2019; 60:201-207. [PMID: 31071525 DOI: 10.1016/j.canep.2019.04.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 04/16/2019] [Accepted: 04/19/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND More men are living following a prostate cancer (PCa) diagnosis. They may need support to maximize the quality of their survival. Physical and psychological impacts of PCa are widely documented. Less is known about social impacts. We aimed to identify key factors associated with social distress following PCa. METHODS The Life After Prostate Cancer Diagnosis study is a UK national cross-sectional survey of men 18-42 months post diagnosis of PCa. Men (n = 58 930) were invited to participate by their diagnosing cancer centre including 82% of English NHS Trusts (n = 111) and 100% of all Health Boards in Northern Ireland (n = 5), Scotland (n = 14) and Wales (n = 6). Social distress was measured using the Social Difficulties Inventory (SDI-21), 16 item Social Distress scale with men assigned to 'socially distressed'/'not socially distressed' groups, according to published guidelines. Clinical and sociodemographic variables were collected from self-report and cancer registries. RESULTS Response rate 60.8% (n = 35 823) of whom 97% (n = 29 351) completed the Social Distress scale (mean age = 71.2; SD = 7.88). The proportion of 'socially distressed' men was 9.4%. Multivariable logistic regression analysis revealed unemployment versus employment (odds ratio (OR): 11.58 [95% CI 9.16-14.63]) and ≥3 co-morbidities versus none (OR: 5.37 [95% CI 4.61-6.27]) as key associations. Others were Androgen Deprivation Therapy, External Beam Radiotherapy in combination with another treatment, age, prior mental health problems and living in a socio-economically deprived area. CONCLUSION Most men following PCa are socially resilient. A simple checklist could help clinicians identify men at risk of social distress.
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Affiliation(s)
- Penny Wright
- Leeds Institute of Medical Research at St James's, University of Leeds, UK.
| | - Sarah Wilding
- Leeds Institute of Medical Research at St James's, University of Leeds, UK; Leeds Institute of Data Analytics, University of Leeds, UK
| | - Eila Watson
- Faculty of Health and Life Sciences, Oxford Brookes University, UK
| | - Amy Downing
- Leeds Institute of Medical Research at St James's, University of Leeds, UK; Leeds Institute of Data Analytics, University of Leeds, UK
| | - Peter Selby
- Leeds Institute of Medical Research at St James's, University of Leeds, UK
| | - Luke Hounsome
- National Cancer Registration and Analysis Service, Public Health England, UK
| | | | - David H Brewster
- Deanery of Molecular, Genetic and Population Health Sciences, University of Edinburgh, UK
| | - Dyfed Huws
- Welsh Cancer Intelligence and Surveillance Unit, Public Health Wales, UK
| | - Hugh Butcher
- Leeds Institute of Medical Research at St James's, University of Leeds, UK
| | - Rebecca Mottram
- Leeds Institute of Medical Research at St James's, University of Leeds, UK; Leeds Institute of Data Analytics, University of Leeds, UK
| | - Therese Kearney
- Northern Ireland Cancer Registry, Queen's University Belfast, Royal Victoria Hospital, Belfast, UK
| | | | - Anna Gavin
- Northern Ireland Cancer Registry, Queen's University Belfast, Royal Victoria Hospital, Belfast, UK
| | - Adam Glaser
- Leeds Institute of Medical Research at St James's, University of Leeds, UK; Leeds Institute of Data Analytics, University of Leeds, UK; Leeds Teaching Hospitals NHS Trust, UK
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26
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Samoborec S, Simpson P, Hassani-Mahmooei B, Ruseckaite R, Giummarra M, Ayton D, Evans S. Impact of comorbidity on health outcome after a transport-related injury. Inj Prev 2019; 26:254-261. [PMID: 31004008 DOI: 10.1136/injuryprev-2019-043195] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 03/26/2019] [Accepted: 03/30/2019] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Understanding the impact of comorbidity on health outcomes is important given that comorbidities can affect survival, morbidity, service delivery costs and healthcare utilisation. However, little is known about the types of comorbidities affecting specific health outcomes after minor to moderate road trauma. METHODS This study involved 1574 participants who claimed injury compensation following transport-related injury. Cross sectional data were collected. Health outcomes were assessed using the EQ-5D-3L specific domains and summary score. Twelve self-reported pre-existing chronic conditions were assessed using a multivariate logistic regression, adjusting for demographic and injury characteristics. RESULTS Out of 1574 participants, only 17 (1%) participants reported no pre-existing comorbidities, 72% reported one, 13% reported two and 14% reported three or more comorbidities. Hypertension (15%), depression (14%) and anxiety (14%) were the most commonly reported comorbidities, followed by arthritis (13%), chronic pain (11%) and asthma (11%). Participants with a history of arthritis (adjusted odds ratio [AOR] 1.90, 95% CI 1.24 to 2.91); chronic back pain (AOR 1.59, 95% CI, 1.04 to 2.43); other chronic pain (AOR 2.73, 95% CI 1.42 to 4.24); depression (AOR 2.55, 95% CI 1.60 to 4.05) and anxiety (AOR 2.08, 95% CI 1.32 to 3.26) were at increased risk of poorer health outcomes, after controlling for age, gender, type of injury and time since injury. CONCLUSION This study found that comorbidities such as arthritis, chronic back pain, other chronic pain, depression and anxiety significantly increase the odds of poorer health postinjury, regardless of the time since injury. Regular screening of comorbid conditions may help identify people likely to have poorer outcomes, thereby enabling the implementation of interventions to optimise health despite the presence of comorbidities.
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Affiliation(s)
- Stella Samoborec
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Pamela Simpson
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | | | - Rasa Ruseckaite
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Melita Giummarra
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Darshini Ayton
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Sue Evans
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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27
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Ho PJ, Tan CS, Shawon SR, Eriksson M, Lim LY, Miao H, Png E, Chia KS, Hartman M, Ludvigsson JF, Czene K, Hall P, Li J. Comparison of self-reported and register-based hospital medical data on comorbidities in women. Sci Rep 2019; 9:3527. [PMID: 30837593 PMCID: PMC6400937 DOI: 10.1038/s41598-019-40072-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 01/31/2019] [Indexed: 12/13/2022] Open
Abstract
Breast cancer patients commonly present with comorbidities which are known to influence treatment decisions and survival. We aim to examine agreement between self-reported and register-based medical records (National Patient Register [NPR]). Ascertainment of nine conditions, using individually-linked data from 64,961 women enrolled in the Swedish KARolinska MAmmography Project for Risk Prediction of Breast Cancer (KARMA) study. Agreement was assessed using observed proportion of agreement (overall agreement), expected proportion of agreement, and Cohen’s Kappa statistic. Two-stage logistic regression models taking into account chance agreement were used to identify potential predictors of overall agreement. High levels of overall agreement (i.e. ≥86.6%) were observed for all conditions. Substantial agreement (Cohen’s Kappa) was observed for myocardial infarction (0.74), diabetes (0.71) and stroke (0.64) between self-reported and NPR data. Moderate agreement was observed for preeclampsia (0.51) and hypertension (0.46). Fair agreement was observed for heart failure (0.40) and polycystic ovaries or ovarian cysts (0.27). For hyperlipidemia (0.14) and angina (0.10), slight agreement was observed. In most subgroups we observed negative specific agreement of >90%. There is no clear reference data source for ascertainment of conditions. Negative specific agreement between NPR and self-reported data is consistently high across all conditions.
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Affiliation(s)
- Peh Joo Ho
- Genome Institute of Singapore, 60 Biopolis Street, Genome, #02-01, Singapore, 138672, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Chuen Seng Tan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Shajedur Rahman Shawon
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Old road campus, OX3 7LF, Oxford, UK
| | - Mikael Eriksson
- Karolinska Institutet, Department of Medical Epidemiology and Biostatistics, Box 281, 171 77, Stockholm, Sweden
| | - Li Yan Lim
- Department of Surgery, University Surgical Cluster, National University Hospital, Singapore, Singapore
| | - Hui Miao
- Genome Institute of Singapore, 60 Biopolis Street, Genome, #02-01, Singapore, 138672, Singapore
| | - Eileen Png
- Genome Institute of Singapore, 60 Biopolis Street, Genome, #02-01, Singapore, 138672, Singapore
| | - Kee Seng Chia
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Mikael Hartman
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore.,Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jonas F Ludvigsson
- Karolinska Institutet, Department of Medical Epidemiology and Biostatistics, Box 281, 171 77, Stockholm, Sweden.,Department of Pediatrics, Örebro University Hospital, Örebro University, Örebro, Sweden
| | - Kamila Czene
- Karolinska Institutet, Department of Medical Epidemiology and Biostatistics, Box 281, 171 77, Stockholm, Sweden
| | - Per Hall
- Karolinska Institutet, Department of Medical Epidemiology and Biostatistics, Box 281, 171 77, Stockholm, Sweden.,Department of Oncology, Södersjukhuset, 118 84, Stockholm, Sweden
| | - Jingmei Li
- Genome Institute of Singapore, 60 Biopolis Street, Genome, #02-01, Singapore, 138672, Singapore. .,Karolinska Institutet, Department of Medical Epidemiology and Biostatistics, Box 281, 171 77, Stockholm, Sweden. .,Department of Surgery, University Surgical Cluster, National University Hospital, Singapore, Singapore.
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28
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Huber M, Kurz C, Leidl R. Predicting patient-reported outcomes following hip and knee replacement surgery using supervised machine learning. BMC Med Inform Decis Mak 2019; 19:3. [PMID: 30621670 PMCID: PMC6325823 DOI: 10.1186/s12911-018-0731-6] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 12/27/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Machine-learning classifiers mostly offer good predictive performance and are increasingly used to support shared decision-making in clinical practice. Focusing on performance and practicability, this study evaluates prediction of patient-reported outcomes (PROs) by eight supervised classifiers including a linear model, following hip and knee replacement surgery. METHODS NHS PRO data (130,945 observations) from April 2015 to April 2017 were used to train and test eight classifiers to predict binary postoperative improvement based on minimal important differences. Area under the receiver operating characteristic, J-statistic and several other metrics were calculated. The dependent outcomes were generic and disease-specific improvement based on the EQ-5D-3L visual analogue scale (VAS) as well as the Oxford Hip and Knee Score (Q score). RESULTS The area under the receiver operating characteristic of the best training models was around 0.87 (VAS) and 0.78 (Q score) for hip replacement, while it was around 0.86 (VAS) and 0.70 (Q score) for knee replacement surgery. Extreme gradient boosting, random forests, multistep elastic net and linear model provided the highest overall J-statistics. Based on variable importance, the most important predictors for post-operative outcomes were preoperative VAS, Q score and single Q score dimensions. Sensitivity analysis for hip replacement VAS evaluated the influence of minimal important difference, patient selection criteria as well as additional data years. Together with a small benchmark of the NHS prediction model, robustness of our results was confirmed. CONCLUSIONS Supervised machine-learning implementations, like extreme gradient boosting, can provide better performance than linear models and should be considered, when high predictive performance is needed. Preoperative VAS, Q score and specific dimensions like limping are the most important predictors for postoperative hip and knee PROMs.
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Affiliation(s)
- Manuel Huber
- German Research Center for Environmental Health, Institute for Health Economics and Health Care Management, Helmholtz Zentrum München, Postfach 1129, 85758 Neuherberg, Germany
| | - Christoph Kurz
- German Research Center for Environmental Health, Institute for Health Economics and Health Care Management, Helmholtz Zentrum München, Postfach 1129, 85758 Neuherberg, Germany
| | - Reiner Leidl
- German Research Center for Environmental Health, Institute for Health Economics and Health Care Management, Helmholtz Zentrum München, Postfach 1129, 85758 Neuherberg, Germany
- Munich Center of Health Sciences, Ludwig-Maximilians-University, Ludwigstr. 28, 80539 Munich, RG Germany
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Health-related quality of life, symptom burden, and comorbidity in long-term survivors of acute promyelocytic leukemia. Leukemia 2018; 33:1598-1607. [DOI: 10.1038/s41375-018-0325-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 10/11/2018] [Accepted: 10/24/2018] [Indexed: 12/18/2022]
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Smith ME, Lee JS, Bonham A, Varban OA, Finks JF, Carlin AM, Ghaferi AA. Effect of new persistent opioid use on physiologic and psychologic outcomes following bariatric surgery. Surg Endosc 2018; 33:2649-2656. [PMID: 30353238 DOI: 10.1007/s00464-018-6542-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Accepted: 10/15/2018] [Indexed: 11/24/2022]
Abstract
INTRODUCTION New persistent opioid use following surgery is a common iatrogenic complication, developing in roughly 6% of patients after elective surgery. Despite increased awareness of misuse and associated morbidity, opioids remain the cornerstone of pain management in bariatric surgery. The potential impact of new persistent opioid use on long-term postoperative outcomes is unknown. We sought to determine the relationship between new persistent opioid use and 1-year postoperative outcomes for patients undergoing bariatric surgery. METHODS Using data from the MBSC registry, we identified patients undergoing primary bariatric surgery between 2006 and 2016. Using previously validated patient-reported survey methodology, we evaluated patient opioid use preoperatively and at 1 year following surgery. New persistent use was defined as a previously opioid-naïve patient who self-reported opioid use 1 year after surgery. We used multivariable logistic regression models to evaluate the association between new persistent opioid use, risk-adjusted weight loss, and psychologic outcomes (psychological wellbeing, body image, and depression). RESULTS 27,799 patients underwent primary bariatric surgery between 2006 and 2016. Among opioid-naïve patients, the rate of new persistent opioid use was 6.3%. At 1-year after surgery, patients with new persistent opioid user lost significantly less excess body weight compared to those without new persistent use (57.6% vs. 60.3%; p < 0.0001). Patients with new persistent opioid use had significantly worse psychological wellbeing (35.0 vs. 33.1; p < 0.0001), body image (19.9 vs. 18.0; p < 0.0001), and depression scores (2.4 vs. 5.0; p < 0.0001). New persistent opioid users also reported less overall satisfaction with their bariatric surgery (75.1% vs. 85.7%; p < 0.0001). CONCLUSIONS New persistent opioid use is common following bariatric surgery and associated with significantly worse physiologic and psychologic outcomes. More effective screening and postoperative surveillance tools are needed to identify these patients, who likely require more aggressive counseling and treatment to maximize the benefits of bariatric surgery.
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Affiliation(s)
- Margaret E Smith
- Department of General Surgery, University of Michigan, Ann Arbor, MI, USA. .,University of Michigan Health System, 1500 E. Medical Center Drive, TC 2110, Ann Arbor, MI, 48109-5346, USA.
| | - Jay S Lee
- Department of General Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Aaron Bonham
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA
| | - Oliver A Varban
- Department of General Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Jonathan F Finks
- Department of General Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Arthur M Carlin
- Department of Surgery, Henry Ford Health System, Detroit, MI, USA
| | - Amir A Ghaferi
- Department of General Surgery, University of Michigan, Ann Arbor, MI, USA
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Williams GR, Deal AM, Lund JL, Chang Y, Muss HB, Pergolotti M, Guerard EJ, Shachar SS, Wang Y, Kenzik K, Sanoff HK. Patient-Reported Comorbidity and Survival in Older Adults with Cancer. Oncologist 2018. [PMID: 29242282 DOI: 10.1634/theoncologist.2017.0404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND Our ability to optimize the care of older adults with cancer and comorbid illnesses is insufficient because most clinical trials lack systematic measurement. The primary purpose of this study was to evaluate the association between patient-reported comorbidity and all-cause mortality using various comorbidity scoring algorithms. MATERIALS AND METHODS The Carolina Senior Registry was linked with the North Carolina Central Cancer Registry to obtain mortality data. Comorbidity was assessed using the patient-reported Older Americans Resources and Services Questionnaire subscale that assesses 13 specific conditions and the degree to which each impairs activities. Multivariable Cox proportional hazard regression models were used to evaluate the association between comorbidities and all-cause mortality. RESULTS The study sample included 539 patients; the median age was 72 years, 72% were female, and 47% had breast cancer. Overall, 92% reported ≥1 comorbid condition, with a mean of 2.7 conditions (range 0-10), with arthritis and hypertension the most common (52% and 50%, respectively). Approximately 60% reported a functional limitation related to comorbidity. After adjusting for time from diagnosis to geriatric assessment, age, cancer type, and stage, the risk of death increased by 5% for each unit increase in comorbidity burden score (adjusted hazard ratio [HR] = 1.05, 95% confidence interval [CI]: 1.01-1.10) and 12% for each comorbid condition impacting function (HR = 1.12, 95% CI: 1.02-1.23). CONCLUSION Comorbid conditions in older adults with cancer are highly prevalent and associated with all-cause mortality, particularly those conditions that impair function. Routine comorbidity assessment should be included in clinical trials and can be measured via a simple one-page patient-reported questionnaire. IMPLICATIONS FOR PRACTICE In order to optimize and personalize the care of older adults with cancer, systematic measurement of comorbidities is necessary in both clinical trials and routine practice. Patient-reported comorbid conditions in older adults with cancer are highly prevalent and are associated with increased risk of all-cause mortality, particularly for those conditions that impair function. Comorbidity can be systematically measured via a one-page patient-reported questionnaire and should be incorporated into future clinical trials and considered for use in oncology clinics to aid in assessing older adults with cancer.
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Affiliation(s)
- Grant R Williams
- Institute for Cancer Outcomes & Survivorship, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Allison M Deal
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina, USA
| | - Jennifer L Lund
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina, USA
| | - YunKyung Chang
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina, USA
| | - Hyman B Muss
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina, USA
| | - Mackenzi Pergolotti
- Department of Occupational Therapy, Colorado State University, Fort Collins, Colorado, USA
| | - Emily J Guerard
- Division of Hematology and Oncology, University of Wisconsin, Madison, Wisconsin, USA
| | - Shlomit Strulov Shachar
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina, USA
- Division of Oncology, Rambam Health Care Campus, Haifa, Israel
| | - Yue Wang
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina, USA
| | - Kelly Kenzik
- Institute for Cancer Outcomes & Survivorship, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Hanna K Sanoff
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina, USA
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Kang DW, Lee EY, An KY, Min J, Jeon JY, Courneya KS. Associations between physical activity and comorbidities in Korean cancer survivors. J Cancer Surviv 2018; 12:441-449. [PMID: 29492754 DOI: 10.1007/s11764-018-0683-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 02/15/2018] [Indexed: 01/01/2023]
Abstract
PURPOSE To examine the associations between physical activity, metabolic risk factors, and comorbidities in Korean cancer survivors. METHODS We used multiple cross-sectional data sets from the 2007-2013 Korean National Health and Nutrition Examination Surveys (KNHANES) that included 1225 cancer survivors. Physical activity and comorbidities were self-reported. Metabolic risk factors were measured via blood analyses and included fasting glucose, insulin, total cholesterol, triglycerides, and blood pressure. RESULTS The sample was 38.4% male with a mean age of 59.9 ± 12.4 years. The most common cancers were stomach (22.5%), cervical (14.6%), breast (14.4%), and colorectal (11.8%). Cancer survivors meeting aerobic physical activity guidelines, compared to those completely inactive, had significantly lower fasting glucose (p = .001), HbA1c (p = .006), and systolic blood pressure (p = .001), and significantly lower risks of hypertension (odds ratio [OR] = 0.55, 95% confidential interval [CI] = 0.32 to 0.93), diabetes (OR = 0.64, 95% CI = 0.43 to 0.95), and arthritis (OR = 0.64, 95% CI = 0.41 to 0.99). Moreover, cancer survivors meeting strength exercise guidelines, compared to those not meeting guidelines, had significantly lower levels of fasting glucose (p = .001), HbA1c (p < .001), and total cholesterol (p = .031), and significantly lower risks of arthritis (OR = 0.42, 95% CI = 0.25 to 0.85) and back pain (OR = 0.50, 95% CI = 0.30 to 0.83). CONCLUSION Aerobic physical activity and strength exercise were significantly associated with lower risks of metabolic disturbances and comorbidities in Korean cancer survivors. IMPLICATIONS FOR CANCER SURVIVORS Cancer survivors should engage in at least 150 min/week of aerobic exercise and at least 2 days/week of strength exercise to lower their risk of metabolic disturbances and comorbidities.
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Affiliation(s)
- Dong-Woo Kang
- Behavioural Medicine Lab, Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB, Canada
| | - Eun-Young Lee
- Kinesiology, Sport, Healthy Active Living and Obesity (HALO) Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Ki Yong An
- Behavioural Medicine Lab, Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB, Canada
| | - Jihee Min
- Department of Sport Industry Studies, Yonsei University, Seoul, Korea
| | - Justin Y Jeon
- Department of Sport Industry Studies, Yonsei University, Seoul, Korea
| | - Kerry S Courneya
- Behavioural Medicine Lab, Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB, Canada.
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Flanders SC, Kim J, Wilson S, Braziunas J, Greenfield S, Billimek J, Lechpammer S, Lin DW, Karsh L, Quinn DI, Shevrin D, Shore ND, Symanowski JT, Penson DF. Validating the total illness burden index for prostate cancer (TIBI-CaP) in men with castration-resistant prostate cancer: data from TRUMPET. Future Oncol 2018; 14:527-536. [PMID: 29417827 PMCID: PMC5941708 DOI: 10.2217/fon-2017-0438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 11/21/2017] [Indexed: 11/21/2022] Open
Abstract
AIM To validate the total illness burden index for prostate cancer (TIBI-CaP) in castration-resistant prostate cancer (CRPC) patients. PATIENTS & METHODS Baseline comorbidity scores collected using the TIBI-CaP were compared with the baseline patient-reported health-related quality of life using the SF-12v2 and FACT-P questionnaires in 302 patients enrolled in the Treatment Registry for Outcomes in CRPC Patients (TRUMPET). RESULTS Baseline TIBI-CaP scores were negatively correlated with all baseline SF-12v2 domain/composite (p < 0.001) and FACT-P subscale/total (p < 0.020) scores. There was a significant decreasing linear trend in SF12v2 and FACT-P scores over the categories based on TIBI-CaP quartiles of comorbidity burden (from 'least' to 'severe'). CONCLUSION The TIBI-CaP is a valid measure of comorbidity burden in patients with CRPC in the real world.
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Affiliation(s)
| | - Janet Kim
- Astellas Pharma, Inc., Northbrook, IL 60062, USA
| | | | | | - Sheldon Greenfield
- Health Policy Research Institute, University of California, Irvine, CA 90024, USA
| | - John Billimek
- Health Policy Research Institute, University of California, Irvine, CA 90024, USA
| | - Stanislav Lechpammer
- Medivation, Inc., which was acquired by Pfizer, Inc. in September 2016, San Francisco, CA 94105, USA
| | - Daniel W Lin
- Department of Urology, University of Washington, Seattle, WA 98195, USA
| | | | - David I Quinn
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA 90089, USA
| | - Daniel Shevrin
- Medical Oncology, North Shore University Health System, Evanston, IL 60201, USA
| | - Neal D Shore
- Carolina Urologic Research Center, Myrtle Beach, SC 29572, USA
| | - James T Symanowski
- Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC 28025, USA
| | - David F Penson
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN 37250, USA
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Abidi L, Oenema A, van den Akker M, van de Mheen D. Do general practitioners record alcohol abuse in the electronic medical records? A comparison of survey and medical record data. Curr Med Res Opin 2018; 34:567-572. [PMID: 29301406 DOI: 10.1080/03007995.2018.1424623] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Primary care professionals are encouraged to screen patients for alcohol abuse. However, patients with alcohol abuse are often under-diagnosed as well as under-registered in medical records in general practices. This study aims to report on the registration rates of alcohol abuse diagnoses in general practices in comparison to patients' self-reported rates of alcohol use disorder. RESEARCH DESIGN AND METHODS Data of a total number of 2,349 patients were analyzed from the SMILE study, a large prospective cohort study conducted in The Netherlands. Two data collection strategies were combined: (1) Patient self-report data on alcohol consumption as well as other sociodemographic characteristics; (2) Medical record (ICPC codes) data of diagnoses of chronic and acute alcohol abuse of the same patients. GPs' registrations of diagnoses were compared with the self-report data using descriptive statistics. RESULTS Based on the results of the patient reported data, 179 (14.8%) male participants had an alcohol use disorder. Of the total number of female patients, 82 (7.2%) had an alcohol use disorder. One of the male and none of the female patients with an alcohol use disorder were registered as such by the GP. CONCLUSIONS This study found that 11.1% of the total patient sample reported an alcohol use disorder, of which a strikingly low number of patients were recorded as such by their GP. It is likely that low recognition due to barriers related to alcohol screening as well as registration avoidance due to the stigma around alcohol abuse play a role in low registration.
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Affiliation(s)
- L Abidi
- a Department of Health Promotion, School of Public Health and Primary Care , Maastricht University , Maastricht , The Netherlands
| | - A Oenema
- a Department of Health Promotion, School of Public Health and Primary Care , Maastricht University , Maastricht , The Netherlands
| | - M van den Akker
- b Department of Family Medicine, School for Public Health and Primary Care , Maastricht University , Maastricht , The Netherlands
- c Academic Center for General Practice/Department of Public Health and Primary Care , KU Leuven , Leuven , Belgium
| | - D van de Mheen
- a Department of Health Promotion, School of Public Health and Primary Care , Maastricht University , Maastricht , The Netherlands
- d Tranzo, School of Social and Behavioral Sciences , Tilburg University , Tilburg , The Netherlands
- e Erasmus Medical Centre , Rotterdam , the Netherlands
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Williams GR, Deal AM, Lund JL, Chang Y, Muss HB, Pergolotti M, Guerard EJ, Shachar SS, Wang Y, Kenzik K, Sanoff HK. Patient-Reported Comorbidity and Survival in Older Adults with Cancer. Oncologist 2017; 23:433-439. [PMID: 29242282 DOI: 10.1634/theoncologist.2017-0404] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 11/21/2017] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Our ability to optimize the care of older adults with cancer and comorbid illnesses is insufficient because most clinical trials lack systematic measurement. The primary purpose of this study was to evaluate the association between patient-reported comorbidity and all-cause mortality using various comorbidity scoring algorithms. MATERIALS AND METHODS The Carolina Senior Registry was linked with the North Carolina Central Cancer Registry to obtain mortality data. Comorbidity was assessed using the patient-reported Older Americans Resources and Services Questionnaire subscale that assesses 13 specific conditions and the degree to which each impairs activities. Multivariable Cox proportional hazard regression models were used to evaluate the association between comorbidities and all-cause mortality. RESULTS The study sample included 539 patients; the median age was 72 years, 72% were female, and 47% had breast cancer. Overall, 92% reported ≥1 comorbid condition, with a mean of 2.7 conditions (range 0-10), with arthritis and hypertension the most common (52% and 50%, respectively). Approximately 60% reported a functional limitation related to comorbidity. After adjusting for time from diagnosis to geriatric assessment, age, cancer type, and stage, the risk of death increased by 5% for each unit increase in comorbidity burden score (adjusted hazard ratio [HR] = 1.05, 95% confidence interval [CI]: 1.01-1.10) and 12% for each comorbid condition impacting function (HR = 1.12, 95% CI: 1.02-1.23). CONCLUSION Comorbid conditions in older adults with cancer are highly prevalent and associated with all-cause mortality, particularly those conditions that impair function. Routine comorbidity assessment should be included in clinical trials and can be measured via a simple one-page patient-reported questionnaire. IMPLICATIONS FOR PRACTICE In order to optimize and personalize the care of older adults with cancer, systematic measurement of comorbidities is necessary in both clinical trials and routine practice. Patient-reported comorbid conditions in older adults with cancer are highly prevalent and are associated with increased risk of all-cause mortality, particularly for those conditions that impair function. Comorbidity can be systematically measured via a one-page patient-reported questionnaire and should be incorporated into future clinical trials and considered for use in oncology clinics to aid in assessing older adults with cancer.
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Affiliation(s)
- Grant R Williams
- Institute for Cancer Outcomes & Survivorship, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Allison M Deal
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina, USA
| | - Jennifer L Lund
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina, USA
| | - YunKyung Chang
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina, USA
| | - Hyman B Muss
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina, USA
| | - Mackenzi Pergolotti
- Department of Occupational Therapy, Colorado State University, Fort Collins, Colorado, USA
| | - Emily J Guerard
- Division of Hematology and Oncology, University of Wisconsin, Madison, Wisconsin, USA
| | - Shlomit Strulov Shachar
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina, USA
- Division of Oncology, Rambam Health Care Campus, Haifa, Israel
| | - Yue Wang
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina, USA
| | - Kelly Kenzik
- Institute for Cancer Outcomes & Survivorship, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Hanna K Sanoff
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina, USA
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Associations between childhood body size and seventeen adverse outcomes: analysis of 65,057 European women. Sci Rep 2017; 7:16917. [PMID: 29208999 PMCID: PMC5717076 DOI: 10.1038/s41598-017-17258-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 11/20/2017] [Indexed: 01/24/2023] Open
Abstract
Large childhood body size has been consistently shown to be associated with decreased breast cancer risk. However, it is important to consider the effects of a large childhood body size on other adult diseases. It is not clear if the associations between childhood body size and adult diseases will persist if they later attain healthy weight. The associations between body size at age 7 and 17 adverse outcomes in adulthood were examined using Cox models in a Swedish study of 65,057 women. Large body size at age 7, when compared to small body size, was associated with decreased risk for breast cancer (HR [95% CI]: 0.81 [0.70–0.93]) and increased risks for anorexia (2.13 [1.63–2.77]) and bulimia (1.91 [1.35–2.70]). Neither adjusting for adult BMI nor restricting the dataset to lean adults (BMI < 25 kg/m2) attenuated the associations. While large body size at age 7 by itself was positively associated with increased risks of diabetes (1.34 [1.16–1.55]), PCOS (1.69 [1.13–2.51]) and hypertension (before age 60), the associations were no longer significant after controlling for adult BMI. No clear associations were found with the remaining adverse outcomes (cervical, uterine, melanoma, colon cancer, depression, ovarian cyst, stroke, hyperlipidemia, heart failure, myocardial infarction, and angina pectoris).
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Blaser DA, Eaneff S, Loudon-Griffiths J, Roberts S, Phan P, Wicks P, Weatherall J. Comparison of rates of nausea side effects for prescription medications from an online patient community versus medication labels: an exploratory analysis. AAPS OPEN 2017. [DOI: 10.1186/s41120-017-0020-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Ade CJ, Broxterman RM, Charvat JM, Barstow TJ. Incidence Rate of Cardiovascular Disease End Points in the National Aeronautics and Space Administration Astronaut Corps. J Am Heart Assoc 2017; 6:JAHA.117.005564. [PMID: 28784652 PMCID: PMC5586420 DOI: 10.1161/jaha.117.005564] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND It is unknown whether the astronaut occupation or exposure to microgravity influences the risk of long-term cardiovascular disease (CVD). This study explored the effects of being a career National Aeronautics and Space Administration (NASA) astronaut on the risk for clinical CVD end points. METHODS AND RESULTS During the Longitudinal Study of Astronaut Health, data were collected on 310 NASA astronauts and 981 nonastronaut NASA employees. The nonastronauts were matched to the astronauts on age, sex, and body mass index, to evaluate acute and chronic morbidity and mortality. The primary outcomes were composites of clinical CVD end points (myocardial infarction, congestive heart failure, stroke, and coronary artery bypass surgery) or coronary artery disease (CAD) end points (myocardial infarction and coronary artery bypass surgery). Of the astronauts, 5.2% had a clinical CVD end point and 2.9% had a CAD end point compared with the nonastronaut comparisons with 4.7% and 3.1% having CVD and CAD end points, respectively. In the multivariate models adjusted for traditional risk factors, astronauts had a similar risk of CVD compared with nonastronauts (adjusted hazard ratio, 1.08; 95% CI, 0.60-1.93; P=0.80). Risk of a CAD end point was similar between groups (hazard ratio, 0.97; CI, 0.45-2.08; P=0.93). In astronauts with early spaceflight experience, the risk of CVD (hazard ratio, 0.80; CI, 0.25-2.56; P=0.71) and CAD (hazard ratio, 1.23; CI: 0.27-5.61; P=0.79) compared with astronauts with no experience were not different. CONCLUSIONS These findings suggest that being an astronaut is not associated with increased long-term risk of CVD development.
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Affiliation(s)
- Carl J Ade
- Department of Kinesiology, Kansas State University, Manhattan, KS
| | - Ryan M Broxterman
- Department of Internal Medicine, University of Utah, Salt Lake City, UT
| | | | - Thomas J Barstow
- Department of Kinesiology, Kansas State University, Manhattan, KS
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