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Escott M, Yi Y, Foret A, Li T, Hsieh M, Delacroix SE, Wu X, Westerman ME. Impact of rural location on receipt of standard of care treatment and survival for locally advanced bladder cancer in Louisiana. Cancer Med 2024; 13:e7301. [PMID: 38923853 PMCID: PMC11199337 DOI: 10.1002/cam4.7301] [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: 11/30/2023] [Revised: 02/22/2024] [Accepted: 05/07/2024] [Indexed: 06/28/2024] Open
Abstract
OBJECTIVE We aim to determine the effect of region of residence (urban vs. rural) on the odds of receiving standard of care treatment for locally advanced BCa in Louisiana and its impact on survival outcomes. METHODS Using the Louisiana Tumor Registry, we identified American Joint Committee on Cancer (AJCC) stage II or III, BCa diagnoses in Louisiana residents between 2010 and 2020. Treatment received was classified as standard or non-standard of care according to American Urological Association (AUA) guidelines and location of residence was determined using Rural Urban Commuting Area-Tract-level 2010 (RUCA). Multivariable logistic regression analyses and multivariate cox proportional hazard analyses were performed. RESULTS Of 983 eligible patients, 85.6% (841/983) lived in urban areas. Overall, only 37.5% received standard-of-care (SOC) for the definitive management of locally advanced bladder cancer. Individuals living in rural areas (OR 0.53, 95% CI: 0.31-0.91, p = 0.02) were less likely to receive standard of care treatment. Both rural residence and receipt of non-standard of care therapy were associated with an increased risk of bladder cancer-specific (adj HR 1.53, 95% CI: 1.09-2.14, p = 0.01 and adj HR: 1.85, 95% CI: 1.43-2.39, <0.0001) and overall mortality (adj HR: 1.28, 95% CI: 1.01-1.61, p = 0.04 and adj HR: 1.73 95% CI: 1.44-2.07, p < 0.0001). CONCLUSIONS Most patients with locally advanced bladder cancer in Louisiana do not receive SOC therapy. Individuals living in rural locations are more likely to receive non-standard of care therapy than individuals in urban areas. Nonstandard of care treatment and rural residence are both associated with worse survival outcomes for Louisiana residents with locally advanced bladder cancer.
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Affiliation(s)
- Megan Escott
- School of MedicineLSU Health Science CenterNew OrleansLouisianaUSA
- Department of UrologyWake Forest University School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Yong Yi
- Louisiana Tumor Registry and EpidemiologyNew OrleansLouisianaUSA
- School of Public HealthLSU Health Science CenterNew OrleansLouisianaUSA
| | - Ashley Foret
- School of MedicineLSU Health Science CenterNew OrleansLouisianaUSA
| | - TingTing Li
- Louisiana Tumor Registry and EpidemiologyNew OrleansLouisianaUSA
- School of Public HealthLSU Health Science CenterNew OrleansLouisianaUSA
| | - Mei‐Chin Hsieh
- Louisiana Tumor Registry and EpidemiologyNew OrleansLouisianaUSA
- School of Public HealthLSU Health Science CenterNew OrleansLouisianaUSA
| | | | - Xiao‐Cheng Wu
- Louisiana Tumor Registry and EpidemiologyNew OrleansLouisianaUSA
- School of Public HealthLSU Health Science CenterNew OrleansLouisianaUSA
| | - Mary E. Westerman
- Department of UrologyLSU Health Science CenterNew OrleansLouisianaUSA
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Adamczak BB, Kuźnik Z, Makles S, Wasilewski A, Kosendiak AA. Physical Activity, Alcohol, and Cigarette Use in Urological Cancer Patients over Time since Diagnosis. Healthcare (Basel) 2023; 12:59. [PMID: 38200965 PMCID: PMC10779175 DOI: 10.3390/healthcare12010059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 12/22/2023] [Accepted: 12/24/2023] [Indexed: 01/12/2024] Open
Abstract
Urological cancers represent a substantial global public health concern, exerting far-reaching effects on both individuals and their families. There is an urgent need to comprehensively understand the transformations in patients' lifestyles and behaviors, given their critical role in the treatment process and overall well-being. This study, involving 128 urological cancer patients, aims to investigate changes in physical activity levels, problematic drinking behaviors assessed through the Alcohol Use Disorders Identification Test (AUDIT), and smoking habits assessed using the Fagerström Test for Nicotine Dependence (FTND) over four distinct time intervals over the subsequent three years from the time of diagnosis and among individuals diagnosed more than three years ago. The results reveal a significant decrease in physical activity levels between study intervals (p < 0.0001), declining from 69% to 45% between the first and second post-diagnosis assessments. Furthermore, the highest levels of problematic substance use, indicated by mean scores, were noted in the first year following diagnosis (AUDIT: 4.20, p = 0.01; FTND: 4.83, p = 0.08). Given the significant impact of physical activity on the prospects of recovery, it is imperative to delve more deeply into the factors contributing to this decline and devise targeted interventions for its improvement. In the context of substance use, it is essential to ascertain whether the initially high levels are a result of coping with the cancer diagnosis or represent a turning point at which patients modify their behaviors and cease their addiction. A more thorough understanding of this phenomenon would enhance the effectiveness of precisely focused interventions.
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Affiliation(s)
- Bartosz Bogusz Adamczak
- Student Scientific Association, Department of Physical Education and Sport, Wroclaw Medical University, 51-601 Wroclaw, Poland
| | - Zofia Kuźnik
- Student Scientific Association, Department of Physical Education and Sport, Wroclaw Medical University, 51-601 Wroclaw, Poland
| | - Szymon Makles
- Student Scientific Association, Department of Physical Education and Sport, Wroclaw Medical University, 51-601 Wroclaw, Poland
| | - Andrzej Wasilewski
- Student Scientific Association, Department of Physical Education and Sport, Wroclaw Medical University, 51-601 Wroclaw, Poland
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Pompa IR, Qi D, Ghosh A, Goldberg SI, Chino F, Efstathiou JA, Kamran SC. Longitudinal Analysis of Bladder Cancer-Specific Mortality Trends in the United States. Bladder Cancer 2023; 9:345-353. [PMID: 38174126 PMCID: PMC10759801 DOI: 10.3233/blc-230062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 11/12/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Bladder cancer is the tenth leading cause of cancer death in the United States (US). Advances in diagnosis, imaging, and treatments have led to improvements in bladder cancer management. OBJECTIVE To evaluate longitudinal bladder cancer mortality trends from 1999-2020 in the US by gender, race, ethnicity, age, geographic region, and urbanization category. METHODS Age-adjusted bladder cancer death and incidence rates of individuals in the US of all ages between 1999-2020 were obtained using the CDC WONDER and NAACCR databases. Trends and average annual percent changes (AAPC) in age-adjusted Bladder Cancer-Specific Mortality (BCSM) and incidence rates were estimated. Data were analyzed from May 2023 to October 2023. RESULTS From 1999-2020, overall BCSM decreased by 0.4% annually, with a dramatic decrease in deaths between 2015-2020 (AAPC: -2.0% [95% CI: -2.6,-1.3]). However, BCSM rates and metastatic malignant bladder cancer incidence rates from 1999-2020 increased for individuals≥85 years old (AAPC for BCSM: 0.8% [95% CI:0.5,1.1]; AAPC for metastatic malignant incidence: 2.5% [95% CI: 2.0,2.9]). Increases in BCSM were found for certain years in the South, in rural areas, and for Non-Hispanic White and Asian or Pacific Islander individuals. CONCLUSIONS Overall mortality from bladder cancer has been decreasing in the US over two decades. Upon disaggregation, increasing trends were found for BCSM and for metastatic malignant bladder cancer incidence for individuals≥85 years old from 1999-2020. Further evaluation of these trends is essential to understand how to target specific populations to improve patient outcomes.
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Affiliation(s)
- Isabella R. Pompa
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - David Qi
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Anushka Ghosh
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Saveli I. Goldberg
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Fumiko Chino
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jason A. Efstathiou
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Sophia C. Kamran
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Dursun F, Elshabrawy A, Wang H, Kaushik D, Liss MA, Svatek RS, Gore JL, Mansour AM. Impact of rural residence on the presentation, management and survival of patients with non-metastatic muscle-invasive bladder carcinoma. Investig Clin Urol 2023; 64:561-571. [PMID: 37932567 PMCID: PMC10630682 DOI: 10.4111/icu.20230125] [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: 04/10/2023] [Revised: 06/15/2023] [Accepted: 07/16/2023] [Indexed: 11/08/2023] Open
Abstract
PURPOSE To assess the impact of rural and remote residence on the receipt of guidelines-recommended treatment, quality of treatment and overall survival (OS) in patients with non-metastatic muscle-invasive bladder cancer (MIBC). MATERIALS AND METHODS Patients with MIBC were identified using National Cancer Database. Patients were classified into three residential areas. Logistic regression models were used to assess associations between geographic residence and receipt of radical cystectomy (RC) or chemoradiation therapy (CRT). Models were fitted to assess quality benchmarks of RC and CRT. RESULTS We identified 71,395 patients. Of those 58,874 (82.5%) were living in Metro areas, 8,534 (11.9%) in urban-rural adjacent (URA), and 3,987 (5.6%) in urban-rural remote to metro area (URR). URR residence was significantly associated with poor OS compared to URA and Metro residence (HR 0.87, 95% CI 0.81-0.94 and HR 0.90, 95% CI 0.87-0.93, p<0.001). There was no difference in the likelihood of receiving RC and CRT among different residential areas. Among patients who underwent RC; individuals living in URR were less likely to receive neoadjuvant chemotherapy and adequate lymph node dissection, and had a higher probability of positive surgical margin than those living in metro areas. For those who received CRT; individuals living in Metro areas were more likely to receive concomitant systemic therapy compared to URR. CONCLUSIONS Rural residence is associated with lower OS for MIBC patients and less likelihood of meeting quality benchmarks for RC and CRT. This data should be used to guide further health policy and allocation of resources for rural population.
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Affiliation(s)
- Furkan Dursun
- Department of Urology, University of Texas Health San Antonio, San Antonio, TX, USA.
| | - Ahmed Elshabrawy
- Department of Urology, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Hanzhang Wang
- Department of Urology, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Dharam Kaushik
- Department of Urology, University of Texas Health San Antonio, San Antonio, TX, USA
- UT Health San Antonio MD Anderson Cancer Center, San Antonio, TX, USA
| | - Michael A Liss
- Department of Urology, University of Texas Health San Antonio, San Antonio, TX, USA
- UT Health San Antonio MD Anderson Cancer Center, San Antonio, TX, USA
| | - Robert S Svatek
- Department of Urology, University of Texas Health San Antonio, San Antonio, TX, USA
- UT Health San Antonio MD Anderson Cancer Center, San Antonio, TX, USA
| | - John L Gore
- Department of Urology, University of Washington, Seattle, WA, USA
| | - Ahmed M Mansour
- Department of Urology, University of Texas Health San Antonio, San Antonio, TX, USA
- UT Health San Antonio MD Anderson Cancer Center, San Antonio, TX, USA
- Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
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Ślusarczyk A, Zapała P, Olszewska-Ślusarczyk Z, Radziszewski P. The prediction of cancer-specific mortality in T1 non-muscle-invasive bladder cancer: comparison of logistic regression and artificial neural network: a SEER population-based study. Int Urol Nephrol 2023; 55:2205-2213. [PMID: 37280316 PMCID: PMC10406653 DOI: 10.1007/s11255-023-03655-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 05/27/2023] [Indexed: 06/08/2023]
Abstract
PURPOSE To identify the risk factors for 5-year cancer-specific (CSS) and overall survival (OS) and to compare the accuracy of logistic regression (LR) and artificial neural network (ANN) in the prediction of survival outcomes in T1 non-muscle-invasive bladder cancer. METHODS This is a population-based analysis using the Surveillance, Epidemiology, and End Results database. Patients with T1 bladder cancer (BC) who underwent transurethral resection of the tumour (TURBT) between 2004 and 2015 were included in the analysis. The predictive abilities of LR and ANN were compared. RESULTS Overall 32,060 patients with T1 BC were randomly assigned to training and validation cohorts in the proportion of 70:30. There were 5691 (17.75%) cancer-specific deaths and 18,485 (57.7%) all-cause deaths within a median of 116 months of follow-up (IQR 80-153). Multivariable analysis with LR revealed that age, race, tumour grade, histology variant, the primary character, location and size of the tumour, marital status, and annual income constitute independent risk factors for CSS. In the validation cohort, LR and ANN yielded 79.5% and 79.4% accuracy in 5-year CSS prediction respectively. The area under the ROC curve for CSS predictions reached 73.4% and 72.5% for LR and ANN respectively. CONCLUSIONS Available risk factors might be useful to estimate the risk of CSS and OS and thus facilitate optimal treatment choice. The accuracy of survival prediction is still moderate. T1 BC with adverse features requires more aggressive treatment after initial TURBT.
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Affiliation(s)
- Aleksander Ślusarczyk
- Department of General, Oncological and Functional Urology, Medical University of Warsaw, Lindleya 4, 02-005 Warsaw, Poland
| | - Piotr Zapała
- Department of General, Oncological and Functional Urology, Medical University of Warsaw, Lindleya 4, 02-005 Warsaw, Poland
| | | | - Piotr Radziszewski
- Department of General, Oncological and Functional Urology, Medical University of Warsaw, Lindleya 4, 02-005 Warsaw, Poland
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Gerald T, Margulis V, Meng X, Bagrodia A, Cole S, Qin Q, Call SG, Mauer E, Lotan Y, Woldu SL. Actionable genomic landscapes from a real-world cohort of urothelial carcinoma patients. Urol Oncol 2023; 41:148.e17-148.e24. [PMID: 36653279 DOI: 10.1016/j.urolonc.2022.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 12/17/2022] [Accepted: 12/23/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Recent targeted therapies for advanced and metastatic urothelial cancer have generated enthusiasm, but the actionable genomic landscape of early-stage disease remains largely unknown. Here, we utilized a large, real-world cohort to comprehensively investigate the incidence of genetic alterations with potential therapeutic implications at all stages of bladder cancer. MATERIALS AND METHODS We retrospectively analyzed next-generation sequencing (NGS) data from 1,562 bladder cancer patients (stages I-IV) with formalin-fixed, paraffin-embedded tumor biopsies sequenced using the Tempus xT solid tumor assay. Incidence of genetic alterations, tumor mutational burden (TMB), microsatellite instability (MSI), and PD-L1 status were assessed and stratified by bladder cancer stage. For patients with tumor-normal match sequencing (n=966), incidental germline alterations in 50 genes were assessed. RESULTS The cohort was composed of 165 stage I-II, 211 stage III, and 1,186 stage IV tumors. TMB-high, PD-L1 positive, and MSI-high status were noted in 14%, 33%, and 0.7% of tumors, respectively, and were similar across stages. Alterations in fibroblast growth factor receptor (FGFR)2/3, homologous recombination repair genes, additional DNA repair gene mutations (ERCC2, RB1, FANCC), and NTRK fusions were detected at similar frequencies across disease stages. We identified a low rate of incidental germline mutations in all tumors (5.2%) and in specific genes: MUTYH (1.9%), BRCA2 (0.5%), and ATM (0.8%). CONCLUSIONS Important subsets of patients demonstrate genetic alterations in potentially actionable molecular pathways at all stages. This analysis found minimal variability in these alterations across stages, providing rationale for early identification of genetic alterations and personalization of therapies at all stages for patients with bladder cancer.
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Affiliation(s)
- Thomas Gerald
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX.
| | - Vitaly Margulis
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Xiaosong Meng
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Aditya Bagrodia
- Department of Urology, University of California San Diego, San Diego, CA
| | - Suzanne Cole
- Division of Hematology Oncology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | - Qian Qin
- Division of Hematology Oncology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | | | | | - Yair Lotan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Solomon L Woldu
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX
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Nelson D, Cooke S, McLeod B, Nanyonjo A, Kane R, Gussy M. A Rapid Systematic Review on the Experiences of Cancer Survivors Residing in Rural Areas during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16863. [PMID: 36554740 PMCID: PMC9778689 DOI: 10.3390/ijerph192416863] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/01/2022] [Accepted: 12/13/2022] [Indexed: 06/17/2023]
Abstract
The COVID-19 pandemic has caused considerable disruption to cancer care and may have exacerbated existing challenges already faced by cancer survivors from rural areas. This has created a need for a rapid evidence synthesis to inform the development of tailored interventions that address the specific needs of rural cancer survivors who continue to be affected by the pandemic. The review was conducted following guidance from the Cochrane Rapid Review Methods Group. Database searches were performed via the EBSCOHost interface (includes MEDLINE, CINAHL, PsycINFO) on 25 May 2022 and supplemented with searches on Google Scholar. Peer-reviewed articles published after March 2020 that reported primary data on the experiences of cancer survivors residing in rural and remote settings during the pandemic were included. Findings were tabulated and written up narratively. Fourteen studies were included. The COVID-19 pandemic had a mostly detrimental impact on the experiences of rural cancer survivors. People's individual coping mechanisms were challenging for a range of reasons. Specifically, the pandemic impacted on their ability to access testing, treatment, check-ups and supportive care, their ability to maintain and access social support with close friends and family, as well as negative consequences to their finances and emotional wellbeing with some reporting feelings of psychological distress including depression and anxiety. This review provides important insight into the experiences of rural cancer survivors that may help inform tailored support in line with the needs and challenges faced because of the pandemic.
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Affiliation(s)
- David Nelson
- Lincoln International Institute for Rural Health, University of Lincoln, Brayford Pool, Lincoln LN6 7TS, UK
- Macmillan Cancer Support, London SE1 7UQ, UK
| | - Samuel Cooke
- School of Health and Social Care, College of Social Science, University of Lincoln, Brayford Pool, Lincoln LN6 7TS, UK
| | - Ben McLeod
- Lincoln Medical School, College of Science, University of Nottingham and University of Lincoln, Lincoln LN6 7TS, UK
| | - Agnes Nanyonjo
- Lincoln International Institute for Rural Health, University of Lincoln, Brayford Pool, Lincoln LN6 7TS, UK
| | - Ros Kane
- School of Health and Social Care, College of Social Science, University of Lincoln, Brayford Pool, Lincoln LN6 7TS, UK
| | - Mark Gussy
- Lincoln International Institute for Rural Health, University of Lincoln, Brayford Pool, Lincoln LN6 7TS, UK
- La Trobe Rural Health School, College of Science, Health and Engineering, La Trobe University, Bendigo, VIC 3086, Australia
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Social Determinants Contribute to Disparities in Test Positivity, Morbidity and Mortality: Data from a Multi-Ethnic Cohort of 1094 GU Cancer Patients Undergoing Assessment for COVID-19. REPORTS 2022. [DOI: 10.3390/reports5030029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: The COVID-19 pandemic exploits existing inequalities in the social determinants of health (SDOH) that influence disease burden and access to healthcare. The role of health behaviours and socioeconomic status in genitourinary (GU) malignancy has also been highlighted. Our aim was to evaluate predictors of patient-level and neighbourhood-level factors contributing to disparities in COVID-19 outcomes in GU cancer patients. Methods: Demographic information and co-morbidities for patients screened for COVID-19 across the Mount Sinai Health System (MSHS) up to 10 June 2020 were included. Descriptive analyses and ensemble feature selection were performed to describe the relationships between these predictors and the outcomes of positive SARS-CoV-2 RT-PCR test, COVID-19-related hospitalisation, intubation and death. Results: Out of 47,379 tested individuals, 1094 had a history of GU cancer diagnosis; of these, 192 tested positive for SARS-CoV-2. Ensemble feature selection identified social determinants including zip code, race/ethnicity, age, smoking status and English as the preferred first language—being the majority of significant predictors for each of this study’s four COVID-19-related outcomes: a positive test, hospitalisation, intubation and death. Patient and neighbourhood level SDOH including zip code/ NYC borough, age, race/ethnicity, smoking status, and English as preferred language are amongst the most significant predictors of these clinically relevant outcomes for COVID-19 patients. Conclusion: Our results highlight the importance of these SDOH and the need to integrate SDOH in patient electronic medical records (EMR) with the goal to identify at-risk groups. This study’s results have implications for COVID-19 research priorities, public health goals, and policy implementations.
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Joshi M, Polimera H, Krupski T, Necchi A. Geography Should Not Be an "Oncologic Destiny" for Urothelial Cancer: Improving Access to Care by Removing Local, Regional, and International Barriers. Am Soc Clin Oncol Educ Book 2022; 42:1-14. [PMID: 35471833 DOI: 10.1200/edbk_350478] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Urothelial cancer care is particularly susceptible to geographical health disparity given its complex nature, requiring access to several specialists such as a urologist, a medical oncologist, a radiation oncologist, a surgical oncologist, and multidisciplinary care teams. Furthermore, other barriers to care access in underserved areas include travel burden, longer wait times, late-stage disease at the time of diagnosis, cost, type of treatment, less enrollment in clinical trials, lack of follow-up among cancer survivors, and less research funding in this area. Here, we discuss the impact of geographical location on access to urothelial cancer care, management decisions, and outcomes and we reflect on how to address geographical disparities in care delivery.
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Affiliation(s)
- Monika Joshi
- Division of Hematology-Oncology, Department of Medicine, Penn State Cancer Institute, Hershey, PA
| | - Hyma Polimera
- Division of Hematology-Oncology, Department of Medicine, Penn State Cancer Institute, Hershey, PA
| | - Tracey Krupski
- Department of Urology, University of Virginia, Charlottesville, VA
| | - Andrea Necchi
- Vita-Salute San Raffaele University, Milan, Italy.,IRCCS Ospedale San Raffaele, Milan, Italy
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Lemiński A, Kaczmarek K, Gołąb A, Kotfis K, Skonieczna-Żydecka K, Słojewski M. Increased One-Year Mortality Among Elderly Patients After Radical Cystectomy for Muscle-Invasive Bladder Cancer: A Retrospective, Observational Comparative Study. Clin Interv Aging 2022; 17:255-263. [PMID: 35299721 PMCID: PMC8922233 DOI: 10.2147/cia.s352890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 02/15/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Muscle invasive bladder cancer (MIBC) is a common malignancy amongst elderly. Increasing life expectancy, prevalence of smoking, lifelong exposure to environmental pollutants and immunosenescence contribute to growing number of cases. Traditionally, radical cystectomy (RC) with pelvic lymph node dissection (PLND) constituted the mainstay of treatment for MIBC, but despite proven feasibility in elderly population, it has been associated with significant burden of morbidity, mortality, and complications. Study Objective We aimed to re-evaluate the safety and efficacy of RC amongst the elderly patients with MIBC. Material and Methods This single-center, retrospective, observational comparative study was conducted among 568 patients who underwent RC due to MIBC between 2003 and 2021. We evaluated the influence of chronological age (<70 vs ≥70 years) on clinical, demographic, and pathological variables related to MIBC and RC. Results Elderly patients had similar clinical and pathological features of disease compared to their younger counterparts; nonetheless, they more often received simplified urinary diversion, ie ureterostomy (60.25% vs 39.33%, p<0.001) and had no PLND (15.76% vs 8.5%, p=0.01) during RC. Furthermore, more elderly patients were treated for secondary MIBCs and fewer had history of smoking. Severe complication and 90-day mortality rates were comparable between groups; however, the elderly had significantly higher all-cause mortality at one year post RC (46.67% vs 33.25%, p=0.003). On multivariate analysis, one-year mortality risk was independently associated with elderly age (HR=2.119, 95% CI: 1.227–3.660, p=0.007), rural residency (HR=1.760, 95% CI: 1.043–2.968, p=0.034), extravesical extension of tumor (HR=2.109, 95% CI: 1.155–3.850, p=0.015), lymph node metastasis (HR=2.268, 95% CI: 1.290–3.987, p=0.004) and omission of PLND (HR=6.064, 95% CI: 2.926–12.568, p<0.001). Conclusion Radical cystectomy in elderly patients is associated with significant one-year mortality. Our study emphasizes the unmet need for considerate planning of treatment for MIBC in potentially vulnerable groups of elderly patients. Efforts are needed to reliably identify those unlikely to benefit from surgery and facilitate patient-centered choice of alternative therapies.
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Affiliation(s)
- Artur Lemiński
- Department of Urology and Urological Oncology, Pomeranian Medical University, Szczecin, Poland
- Correspondence: Artur Lemiński, Department of Urology and Urological Oncology, Pomeranian Medical University, al. Powstańców Wielkopolskich 72, Szczecin, 70-111, Poland, Tel +48-91-466-1101, Fax +48-91-466-1100, Email
| | - Krystian Kaczmarek
- Department of Urology and Urological Oncology, Pomeranian Medical University, Szczecin, Poland
| | - Adam Gołąb
- Department of Urology and Urological Oncology, Pomeranian Medical University, Szczecin, Poland
| | - Katarzyna Kotfis
- Department of Anesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University, Szczecin, Poland
- Katarzyna Kotfis, Department of Anesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University, al. Powstańców Wielkopolskich 72, Szczecin, 70-111, Poland, Tel +48-91-466-1146, Fax +48-91-466-1144, Email
| | | | - Marcin Słojewski
- Department of Urology and Urological Oncology, Pomeranian Medical University, Szczecin, Poland
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Ethipatogenetic Study of Urothelial Carcinomas in the Urology Clinic of the County Clinical Hospital of Constanta. ARS MEDICA TOMITANA 2021. [DOI: 10.2478/arsm-2021-0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Abstract
Bladder cancer is the most common malignancy involving the urinary system, urothelial carcinoma of the upper tract is a rare subgroup of urothelial cancers with poor prognosis, being the most common histological type of bladder cancer (approximately 90%), manifesting as invasion of the basal membrane (or deeper) by neoplastic cells of urothelial origin.
This type of carcinoma is more common in men than women, with a male to female ratio of 2:1, with men being 3 to 4 times more likely to develop bladder cancer than women.
The present study is a retrospective study including 174 patients in the Urology Clinic of Constanta County St. Apostle Andrew Emergency Hospital in the period 2016-2020. Patients were divided into 2 groups: Group A and Group B. Group A includes patients with anatomopathologically confirmed diagnosis of urothelial carcinoma, while in Group B are patients who do not present a diagnosis of urothelial carcinomas.
In this study the influence of environmental factors on the occurrence of urothelial carcinomas was compared in order to draw conclusions on the occurrence and development of these types of neoplasms.
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