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Sun R, Sun D, Zhu L, Sun J. Regression analysis of general mixed recurrent event data. LIFETIME DATA ANALYSIS 2023; 29:807-822. [PMID: 37438585 DOI: 10.1007/s10985-023-09604-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 06/23/2023] [Indexed: 07/14/2023]
Abstract
In modern biomedical datasets, it is common for recurrent outcomes data to be collected in an incomplete manner. More specifically, information on recurrent events is routinely recorded as a mixture of recurrent event data, panel count data, and panel binary data; we refer to this structure as general mixed recurrent event data. Although the aforementioned data types are individually well-studied, there does not appear to exist an established approach for regression analysis of the three component combination. Often, ad-hoc measures such as imputation or discarding of data are used to homogenize records prior to the analysis, but such measures lead to obvious concerns regarding robustness, loss of efficiency, and other issues. This work proposes a maximum likelihood regression estimation procedure for the combination of general mixed recurrent event data and establishes the asymptotic properties of the proposed estimators. In addition, we generalize the approach to allow for the existence of terminal events, a common complicating feature in recurrent event analysis. Numerical studies and application to the Childhood Cancer Survivor Study suggest that the proposed procedures work well in practical situations.
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Affiliation(s)
- Ryan Sun
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Dayu Sun
- Department of Biostatistics, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | | | - Jianguo Sun
- Department of Statistics, University of Missouri, Columbia, MO, USA
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2
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Dias de Oliveira G, Oancea SC, Nucci LB, Vogeltanz-Holm N. The association between obesity and self-reported current depression among adult cancer survivors residing in Brazil. Int Health 2019; 11:580-588. [PMID: 31294775 DOI: 10.1093/inthealth/ihz027] [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: 01/10/2019] [Revised: 03/16/2019] [Accepted: 04/01/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The purpose of the current study was to investigate the association between obesity and self-reported current depression (SRCD) in a population-based sample of adult Brazilian cancer survivors. METHODS The sample for this study (N=930) was based on the 2013 Brazilian National Health Survey. SRCD was assessed using the 8-item Patient Health Questionnaire (PHQ-8). Obesity was defined as a body mass index ≥30 kg/m2. Multivariable weighted logistic regression models were conducted to investigate the association between obesity and SRCD among Brazilian adult cancer survivors. RESULTS The weighted prevalence of obesity and SRCD among adult cancer survivors was 26.4% (95% confidence interval [CI] 22.5 to 30.3%) and 13.7% (95% CI 10.4 to 17.1%), respectively. Overall there was no significant weighted and adjusted association between obesity and SRCD among cancer survivors (adjusted odds ratio [AOR] 0.99 [95% CI 0.56 to 1.73]). Nevertheless, among cancer survivors of working age (18-59 y), this association was significant (AOR 2.19 [95% CI 1.28 to 3.73]) and therefore obesity is significantly associated with a 119% increase in the odds of SRCD among Brazilian adult cancer survivors of working age. CONCLUSIONS Since both obesity and depression may lead to worse health and quality of life outcomes in this young and middle-aged population, further investigations are needed in order to establish the causality and directionality of this association.
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Affiliation(s)
- Gisele Dias de Oliveira
- Department of Community and Health Values Integration, Centura Health, 91000 E. Mineral Circle, Centennial, CO, USA
| | - S Cristina Oancea
- Department of Population Health, School of Medicine and Health Sciences, University of North Dakota, 1301 North Columbia Road, Grand Forks, ND, USA
| | - Luciana B Nucci
- Health Sciences Post Graduate Program, School of Medicine, Center for Life Sciences, Pontifical Catholic University of Campinas, Av. John Boyd Dunlop, s/n-Jd. Ipaussurama, Campinas-São Paulo/CEP:, Brazil
| | - Nancy Vogeltanz-Holm
- Center for Health Promotion and Prevention Research, School of Medicine and Health Sciences, University of North Dakota, 1301 North Columbia Road, Grand Forks, ND, USA
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Zabih V, Kahane A, O'Neill NE, Ivers N, Nathan PC. Interventions to improve adherence to surveillance guidelines in survivors of childhood cancer: a systematic review. J Cancer Surviv 2019; 13:713-729. [PMID: 31338733 DOI: 10.1007/s11764-019-00790-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 07/11/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE Many survivors of childhood cancer are at high risk of late effects of their cancer therapy, including cardiac toxicity and subsequent malignant neoplasms (SMN). Current North American guidelines recommend periodic surveillance for these late effects. We conducted a systematic review of the literature to estimate rates of adherence to recommended surveillance and summarize studies evaluating interventions intended to increase adherence. METHODS We searched MEDLINE, Embase, Web of Science, and the Cumulative Index of Nursing and Allied Health Literature (CINAHL) for articles published between January 2000 and September 2018 that reported adherence to surveillance for cardiac toxicity and SMN (breast and colorectal cancer) and interventions implemented to improve completion of recommended testing. Risk of bias was assessed using relevant Cochrane checklists. Due to heterogeneity and overlapping study populations, we used narrative synthesis to summarize the findings. This review was registered in PROSPERO: CRD42018098878. RESULTS Thirteen studies met our inclusion criteria for assessing adherence to surveillance, while five assessed interventions to improve rates of surveillance. No studies met criteria for low risk of bias. Completion of recommended surveillance was lowest for colorectal cancer screening (11.5-30.0%) followed by cardiomyopathy (22.3-48.1%) and breast cancer (37.0-56.5%). Factors such as patient-provider communication, engagement with the health care system, and receipt of information were consistently reported to be associated with higher rates of surveillance. Of five randomized controlled trials aimed at improving surveillance, only two significantly increase completion of recommended testing-one for echocardiography and one for mammography. Both involved telephone outreach to encourage and facilitate these tests. CONCLUSION The majority of childhood cancer survivors at high risk of cardiac toxicity or SMN do not receive evidence-based surveillance. There is paucity of rigorous studies evaluating interventions to increase surveillance in this population. IMPLICATIONS FOR CANCER SURVIVORS Robust trials are needed to assess whether tailored interventions, designed based on unique characteristics and needs of each survivor population, could improve adherence.
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Affiliation(s)
- Veda Zabih
- Division of Hematology/Oncology, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | | | | | - Noah Ivers
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Paul C Nathan
- Division of Hematology/Oncology, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
- Institute of Health Policy Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
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Oeffinger KC, Ford JS, Moskowitz CS, Chou JF, Henderson TO, Hudson MM, Diller L, McDonald A, Ford J, Mubdi NZ, Rinehart D, Vukadinovich C, Gibson TM, Anderson N, Elkin EB, Garrett K, Rebull M, Leisenring W, Robison LL, Armstrong GT. Promoting Breast Cancer Surveillance: The EMPOWER Study, a Randomized Clinical Trial in the Childhood Cancer Survivor Study. J Clin Oncol 2019; 37:2131-2140. [PMID: 31260642 PMCID: PMC6698920 DOI: 10.1200/jco.19.00547] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The aim of the current study was to increase the uptake of screening mammography among high-risk women who were treated for a childhood cancer with chest radiotherapy. PATIENTS AND METHODS Two hundred four female survivors in the Childhood Cancer Survivor Study who were treated with chest radiotherapy with 20 Gy or greater, age 25 to 50 years, and without breast imaging in the past 24 months were randomly assigned 2:1 to receive a mailed informational packet followed by a tailored telephone-delivered brief motivational interview (intervention) versus an attention control. Primary outcome was the difference in the proportion of participants who completed a screening mammogram by 12 months as evaluated in an intent-to-treat analysis. Stratum-adjusted relative risk (RR) and 95% CI were estimated using the Cochran-Mantel-Haenszel method. Secondary outcomes included the completion of screening breast magnetic resonance imaging (MRI) and barriers to screening and moderating factors. RESULTS Women in the intervention group were significantly more likely than those in the control group to report a mammogram (45 [33.1%] of 136 v 12 [17.6%] of 68; RR, 1.9; 95% CI, 1.1 to 3.3). The intervention was more successful among women age 25 to 39 years (RR, 2.2; 95% CI, 1.1 to 4.7) than among those age 40 to 50 years (RR, 1.4; 95% CI, 0.6 to 3.2). The proportion of women who reported a breast MRI at 12 months was similar between the two groups: 16.2% (intervention) compared with 13.2% (control; RR, 1.2; 95% CI, 0.6 to 2.5). Primary barriers to completing a screening mammogram and/or breast MRI included lack of physician recommendation, deferred action by survivor, cost, and absence of symptoms. CONCLUSION Use of mailed materials followed by telephone-delivered counseling increased mammography screening rates in survivors at high risk for breast cancer; however, this approach did not increase the rate of breast MRI. Cost of imaging and physician recommendation were important barriers that should be addressed in future studies.
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Affiliation(s)
| | - Jennifer S Ford
- 2Hunter College, City University of New York, New York, NY.,3The Graduate Center of the City University of New York, New York, NY
| | | | - Joanne F Chou
- 4Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | - Lisa Diller
- 7Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | | | - James Ford
- 6St Jude Children's Research Hospital, Memphis, TN
| | - Nidha Z Mubdi
- 4Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | | | | | - Elena B Elkin
- 4Memorial Sloan Kettering Cancer Center, New York, NY
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Patterns and drivers of health care use in long-term childhood cancer survivors: A systematic review. Crit Rev Oncol Hematol 2017; 120:60-76. [DOI: 10.1016/j.critrevonc.2017.10.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 09/03/2017] [Accepted: 10/10/2017] [Indexed: 11/17/2022] Open
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Clinical and diagnosis characteristics of breast cancers in women with a history of radiotherapy in the first 30years of life: A French multicentre cohort study. Radiother Oncol 2017; 124:200-203. [PMID: 28733054 DOI: 10.1016/j.radonc.2017.06.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 06/22/2017] [Accepted: 06/29/2017] [Indexed: 11/21/2022]
Abstract
PURPOSE Irradiation (>3Gy) to the breast or axillae before 30years of age increases the risk of secondary breast cancer (SBC). The purpose of this article is to describe the clinical characteristics of SBC and the way of diagnosis in young women (before the age of national screening) in France who had received previous radiotherapy for a childhood or a young adulthood cancer. PATIENTS AND METHODS This retrospective, multicentre study reviewed the medical records of women with SBC before the age of the national screening who had received irradiation (≥3Gy) on part or all of the breast before 30years of age, for any type of tumour except BC. RESULTS A total of 121 SBC were detected in 104 women with previous radiotherapy. Twenty percent of SBC were detected during regular breast screening and 16% of the women had a regular radiological follow-up. CONCLUSION Our results points out that the main proportion of childhood cancer survivors did not benefit from the recommended breast cancer screening. This result is comparable to other previously published studies in other countries. A national screening programme is necessary and should take into account the patient's age, family history, personal medical history and previous radiotherapy to reduce the number of SBC diagnosed at an advanced stage.
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Hodgson D, van Leeuwen F, Ng A, Morton L, Henderson TO. Breast Cancer After Childhood, Adolescent, and Young Adult Cancer: It's Not Just About Chest Radiation. Am Soc Clin Oncol Educ Book 2017; 37:736-745. [PMID: 28561716 DOI: 10.1200/edbk_175668] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Women who have been treated for a childhood, adolescent, or young adult cancer are at an increased risk for developing breast cancer at a young age, and breast cancer accounts for the most common subsequent malignant neoplasm among female childhood and adolescent cancer survivors. Risk of breast cancer in these survivors appears to be a multifaceted relationship between constitutional factors, exposures to radiation therapy (RT) and chemotherapy, and genetic predisposition. Given the significant morbidities and mortality associated with a breast cancer diagnosis, it is imperative that health care providers understand the risks, biology and genetics, recommended surveillance guidelines for early detection, and potential prevention strategies for women who have survived pediatric and young adult cancer.
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Affiliation(s)
- David Hodgson
- From the University of Toronto, Toronto, Ontario; Netherlands Cancer Institute, Amsterdam, Netherlands; Dana-Farber Cancer Institute, Boston, MA; National Cancer Institute, Bethesda, MD; University of Chicago, Chicago, IL
| | - Flora van Leeuwen
- From the University of Toronto, Toronto, Ontario; Netherlands Cancer Institute, Amsterdam, Netherlands; Dana-Farber Cancer Institute, Boston, MA; National Cancer Institute, Bethesda, MD; University of Chicago, Chicago, IL
| | - Andrea Ng
- From the University of Toronto, Toronto, Ontario; Netherlands Cancer Institute, Amsterdam, Netherlands; Dana-Farber Cancer Institute, Boston, MA; National Cancer Institute, Bethesda, MD; University of Chicago, Chicago, IL
| | - Lindsay Morton
- From the University of Toronto, Toronto, Ontario; Netherlands Cancer Institute, Amsterdam, Netherlands; Dana-Farber Cancer Institute, Boston, MA; National Cancer Institute, Bethesda, MD; University of Chicago, Chicago, IL
| | - Tara O Henderson
- From the University of Toronto, Toronto, Ontario; Netherlands Cancer Institute, Amsterdam, Netherlands; Dana-Farber Cancer Institute, Boston, MA; National Cancer Institute, Bethesda, MD; University of Chicago, Chicago, IL
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