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Flynn MS, Gayed M, Lebhar J, Jacobs J, Bailey-Burke C, Tissera K, Liu B, Green C, Pavlis MB, Mosca PJ. Association of rurality and health professional shortages with the clinicopathologic characteristics of melanoma in North Carolina. J Rural Health 2024. [PMID: 39363437 DOI: 10.1111/jrh.12881] [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] [Received: 05/30/2024] [Revised: 08/07/2024] [Accepted: 09/11/2024] [Indexed: 10/05/2024]
Abstract
PURPOSE To assess rural-urban and health professional shortage area (HPSA)-related influences on the characteristics of melanoma in North Carolina. METHODS We conducted a single-center retrospective cohort study of patients living in North Carolina with an available pathology report for invasive cutaneous melanoma seen in the Duke University Health System from 01/01/2014 to 12/31/2020. Multivariable logistic regression models were employed to compare patient and tumor characteristics between rural versus urban county residence as well between melanoma thicknesses dichotomized into thin (≤1.0 mm) and thicker (>1.0 mm) tumors. FINDINGS The cohort included 807 patients, and rural patients accounted for 177 (21.9%) of invasive cutaneous melanomas. Rural patients had significantly higher odds of having thicker tumors than urban patients (odds ratio [OR] = 1.78, 95% confidence interval [CI]: 1.17-2.71; P = .008). Rural patients were significantly more likely to be female (OR = 1.59, 95% CI: 1.10-2.28; P = .013) and located in a population-based (OR = 2.66, 95% CI: 1.84-3.84; P<.001) or geographic-based (OR = 8.21, 95% CI: 3.33-20.22; P<.001) HPSA. Living in a medium- or high-shortage population-based HPSA was associated with higher odds of thicker tumors (OR = 2.65, 95% CI: 1.85-3.80; P<.001). CONCLUSIONS Patients living in rural North Carolina counties were more likely than those in urban counties to be diagnosed with melanomas >1.0 mm in thickness, a clinically significant difference with important prognostic implications. Interventions at the county- and state-level to address this disparity may include improving access to skin cancer screening and teledermatology programs, increasing partnerships with primary care providers, and targeting interventions to counties with health professional shortages.
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Affiliation(s)
- Michael Seth Flynn
- Department of Dermatology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Matthew Gayed
- Department of Dermatology, Duke University Medical Center, Durham, North Carolina, USA
| | - Jamie Lebhar
- Department of Dermatology, Duke University Medical Center, Durham, North Carolina, USA
| | - Jennifer Jacobs
- Department of Dermatology, Duke University Medical Center, Durham, North Carolina, USA
| | | | - Kristin Tissera
- Department of Dermatology, Duke University Medical Center, Durham, North Carolina, USA
| | - Beiyu Liu
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, USA
| | - Cynthia Green
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, USA
| | - Michelle B Pavlis
- Department of Dermatology, Duke University Medical Center, Durham, North Carolina, USA
| | - Paul J Mosca
- Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
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Alter DA, Austin PC, Rosenfeld A. The Dynamic Nature of the Socioeconomic Determinants of Cardiovascular Health: A Narrative Review. Can J Cardiol 2024; 40:989-999. [PMID: 38309464 DOI: 10.1016/j.cjca.2024.01.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 01/08/2024] [Accepted: 01/14/2024] [Indexed: 02/05/2024] Open
Abstract
Despite decades of social epidemiologic research, health inequities remain pervasive and ubiquitous in Canada and elsewhere. One reason may be our use of socioeconomic measurement, which has often relied on single point-in-time exposures. To explore the extent to which researchers have incorporated dynamic socioeconomic measurement into cardiovascular health outcome evaluations, we performed a narrative review. We estimated the prevalence of socioeconomic longitudinal cardiovascular research studies that identified socioeconomic exposures at 2 or more points in time between the years of 2019 and 2023. We defined cardiovascular outcome studies as those that examined coronary artery disease, myocardial infarction, acute coronary syndrome, stroke, heart failure, cardiac arrhythmias, cardiac death, cardiometabolic factors, transient ischemic attacks, peripheral artery disease, or hypertension. Socioeconomic exposures included individual income, neighbourhood income, intergenerational social mobility, education, occupation, insurance status, and economic security. Seven percent of socioeconomic cardiovascular outcome studies have measured socioeconomic status at 2 or more points in time throughout the follow-up period, hypothesized mechanisms by which dynamic socioeconomic measures affected outcome focused on social mobility, accumulation, and critical period theories. Insights, implications, and future directions are discussed, in which we highlight ways in which postal code data can be better used methodologically as a dynamic socioeconomic measure. Future research must incorporate dynamic socioeconomic measurement to better inform root causes, interventions, and health-system designs if health equity is to be improved.
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Affiliation(s)
- David A Alter
- ICES, Sunnybrook Health Sciences, Toronto, Ontario, Canada; Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada; Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
| | - Peter C Austin
- ICES, Sunnybrook Health Sciences, Toronto, Ontario, Canada; Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Aaron Rosenfeld
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
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van Zwieten A, Dai J, Blyth FM, Wong G, Khalatbari-Soltani S. Overadjustment bias in systematic reviews and meta-analyses of socio-economic inequalities in health: a meta-research scoping review. Int J Epidemiol 2024; 53:dyad177. [PMID: 38129958 PMCID: PMC10859162 DOI: 10.1093/ije/dyad177] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 12/05/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Overadjustment bias occurs when researchers adjust for an explanatory variable on the causal pathway from exposure to outcome, which leads to biased estimates of the causal effect of the exposure. This meta-research review aimed to examine how previous systematic reviews and meta-analyses of socio-economic inequalities in health have managed overadjustment bias. METHODS We searched Medline and Embase until 16 April 2021 for systematic reviews and meta-analyses of observational studies on associations between individual-level socio-economic position and health outcomes in any population. A set of criteria were developed to examine methodological approaches to overadjustment bias adopted by included reviews (rated Yes/No/Somewhat/Unclear). RESULTS Eighty-four reviews were eligible (47 systematic reviews, 37 meta-analyses). Regarding approaches to overadjustment, whereas 73% of the 84 reviews were rated as Yes for clearly defining exposures and outcomes, all other approaches were rated as Yes for <55% of reviews; for instance, 5% clearly defined confounders and mediators, 2% constructed causal diagrams and 35% reported adjusted variables for included studies. Whereas only 2% included overadjustment in risk of bias assessment, 54% included confounding. Of the 37 meta-analyses, 16% conducted sensitivity analyses related to overadjustment. CONCLUSIONS Our findings suggest that overadjustment bias has received insufficient consideration in systematic reviews and meta-analyses of socio-economic inequalities in health. This is a critical issue given that overadjustment bias is likely to result in biased estimates of health inequalities and accurate estimates are needed to inform public health interventions. There is a need to highlight overadjustment bias in review guidelines.
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Affiliation(s)
- Anita van Zwieten
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Centre for Kidney Research, Children’s Hospital at Westmead, Westmead, NSW, Australia
| | - Jiahui Dai
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Fiona M Blyth
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- ARC Centre of Excellence in Population Ageing Research (CEPAR), University of Sydney, Sydney, NSW, Australia
| | - Germaine Wong
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Centre for Kidney Research, Children’s Hospital at Westmead, Westmead, NSW, Australia
- Centre for Transplant and Renal Research, Westmead Hospital, Westmead, NSW, Australia
| | - Saman Khalatbari-Soltani
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- ARC Centre of Excellence in Population Ageing Research (CEPAR), University of Sydney, Sydney, NSW, Australia
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Alli S, LeBeau J, Hasbani A, Lagacé F, Litvinov IV, Peláez S. Understanding the Perceived Relationship between Sun Exposure and Melanoma in Atlantic Canada: A Consensual Qualitative Study Highlighting a "Sunscreen Paradox". Cancers (Basel) 2023; 15:4726. [PMID: 37835419 PMCID: PMC10571640 DOI: 10.3390/cancers15194726] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 09/19/2023] [Accepted: 09/21/2023] [Indexed: 10/15/2023] Open
Abstract
Globally, cutaneous melanoma (CM) incidence is increasing, with sun exposure identified as a key modifiable risk factor. The Atlantic provinces of Canada display varied CM incidence rates: New Brunswick aligns with the national average, while Nova Scotia and Prince Edward Island exceed it, and Newfoundland and Labrador fall below this benchmark. We investigated the relationship between sun exposure and CM in these provinces. Twenty-two focus groups encompassing 95 Atlantic Canada residents were conducted and transcribed. A thematic analysis was conducted in MAXQDA using the social-ecological model as a framework. Residents of high-CM incidence provinces demonstrated greater sun exposure awareness, consulting UV indices, and using sunscreen and sun-protective clothing. However, they received greater UV exposure due to warmer climates and outdoor work and cultural activities. Conversely, those in low-incidence provinces used sunscreen and sun-protective clothing less often, engaged in occupations and hobbies affording less sun exposure, and lived in cooler climates. Our data supports a possible "sunscreen paradox", whereby increased sunscreen use is correlated with augmented sun exposure, leading to a deceptive sense of security. Public health initiatives in Atlantic Canada promoting sun safety must address this paradox while integrating community-specific behaviors and norms in order to develop tailored campaigns.
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Affiliation(s)
- Sauliha Alli
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada;
| | - Jonathan LeBeau
- Faculty of Medicine and Health Sciences, McGill University, Montreal, QC H3T 1C5, Canada; (J.L.); (A.H.); (F.L.)
| | - Agustina Hasbani
- Faculty of Medicine and Health Sciences, McGill University, Montreal, QC H3T 1C5, Canada; (J.L.); (A.H.); (F.L.)
| | - François Lagacé
- Faculty of Medicine and Health Sciences, McGill University, Montreal, QC H3T 1C5, Canada; (J.L.); (A.H.); (F.L.)
| | - Ivan V. Litvinov
- Faculty of Medicine and Health Sciences, McGill University, Montreal, QC H3T 1C5, Canada; (J.L.); (A.H.); (F.L.)
| | - Sandra Peláez
- School of Kinesiology and Physical Activity Sciences, Faculty of Medicine, University of Montreal, Montreal, QC H4A 3J1, Canada
- Research Centre of Sainte-Justine University Hospital, Montreal, QC H3T 1C5, Canada
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Sandström N, Johansson M, Jekunen A, Andersén H. Socioeconomic status and lifestyle patterns in the most common cancer types-community-based research. BMC Public Health 2023; 23:1722. [PMID: 37670311 PMCID: PMC10478285 DOI: 10.1186/s12889-023-16677-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 09/01/2023] [Indexed: 09/07/2023] Open
Abstract
INTRODUCTION As the global burden of chronic cancer increases, its correlation to lifestyle, socioeconomic status (SES) and health equity becomes more important. The aim of the present study was to provide a snapshot of the socioeconomic and lifestyle patterns for different cancer types in patients at a Nordic tertiary cancer clinic. MATERIALS AND METHODS In a descriptive observational study, questionnaires addressed highest-attained educational level, occupational level, economy, relationship status, exposures, and lifestyle habits. The questionnaire was distributed to all cancer patients attending the cancer clinic. Treating physicians added further information about the cancer disease, including primary origin, pathology report, TNM-classification and stage. RESULTS Patients with lung cancer had the lowest SES, and patients with gastrointestinal (GI) cancer, other cancer types and prostate cancer had the second, third and fourth lowest SES, respectively. However, breast cancer patients had the highest SES. Lifestyle and exposure patterns differed among the major cancer types. Lung cancer patients reported the highest proportion of unfavourable lifestyle and exposure patterns, and patients with GI cancer, prostate cancer and other cancer types had the second, third and fourth highest proportion of unfavourable lifestyle and exposure patterns, respectively. The most favourable exposure and lifestyle patterns were observed in breast cancer patients. CONCLUSIONS The present study indicated significant socioeconomic and lifestyle differences among cancer types at a Nordic cancer centre, with differences in lifestyle being more prominent than socioeconomic differences.
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Affiliation(s)
- Niclas Sandström
- Cancer Clinic, Vaasa Central Hospital, Sandviksgatan 2-4, 65130, Vaasa, Finland
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
| | - Mikael Johansson
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
| | - Antti Jekunen
- Cancer Clinic, Vaasa Central Hospital, Sandviksgatan 2-4, 65130, Vaasa, Finland
- Faculty of Medicine, University of Turku, Turku, Finland
| | - Heidi Andersén
- Cancer Clinic, Vaasa Central Hospital, Sandviksgatan 2-4, 65130, Vaasa, Finland.
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
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Lagacé F, Noorah BN, Conte S, Mija LA, Chang J, Cattelan L, LeBeau J, Claveau J, Turchin I, Gulliver W, Gniadecki R, Netchiporouk E, Miller Jr. WH, Salopek TG, Rahme E, Peláez S, Litvinov IV. Assessing Skin Cancer Risk Factors, Sun Safety Behaviors and Melanoma Concern in Atlantic Canada: A Comprehensive Survey Study. Cancers (Basel) 2023; 15:3753. [PMID: 37568569 PMCID: PMC10417242 DOI: 10.3390/cancers15153753] [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] [Received: 04/19/2023] [Revised: 07/10/2023] [Accepted: 07/20/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND The incidence of cutaneous melanoma (CM) is increasing at an alarming rate in Canada and elsewhere around the world. Significant regional differences in CM incidence have been identified in Atlantic provinces. The goal of this study is to compare ultraviolet exposure, sun protective behaviours, level of worry and baseline CM knowledge in provinces with a high versus low incidence of CM as well, as between various demographic groups. METHODS A cross-sectional survey study was conducted in Atlantic provinces between July 2020 and August 2022. All participants aged ≥ 16 years with a completed survey were eligible. Survey responses were summarized using frequency counts, percentages, and means. Two-sided Z-tests for equality of proportions and logistic regression models were used to compare the survey results between geographic and demographic groups. RESULTS In total, 7861 participants were included (28.0% men; mean age 61.3 years; response rate 28%). Our results (gender- and age-adjusted odds ratio, 95% confidence interval) show that high-incidence provinces for CM (Prince Edward Island and Nova Scotia) had significantly more sunburns (OR 2.00, 1.72-2.31), total sun exposure (OR 2.05, 1.68-2.50), recreational sun exposure (OR 1.95, 1.61-2.35) and tans (OR 1.77, 1.53-2.05) than individuals in low-incidence provinces (Newfoundland and Labrador). However, individuals in high-incidence provinces displayed more protective behaviors: there were less tanning bed users (OR 0.82, 0.71-0.95), they checked their skin more frequently for new moles (OR 1.26, 1.06-1.51) and practiced more sun protection overall. Additional analyses are presented based on education, income, sexual orientation and gender. DISCUSSION These findings suggest that future efforts aimed at reducing the CM burden in Atlantic Canada should be tailored for target geographic and/or demographic groups. LIMITATIONS the study participants are not representative of the population in Atlantic Canada due to recruitment strategies.
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Affiliation(s)
- François Lagacé
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, QC H4A 3J1, Canada; (F.L.)
| | - Bibi Nuzha Noorah
- Faculté de Médecine, Université de Montréal, Montréal, QC H3T 1J4, Canada
| | - Santina Conte
- Department of Medicine, Faculty of Medicine and Health Sciences, McGill University, Montréal, QC H4A 3J1, Canada
| | | | - Jasmine Chang
- Department of Family Medicine, McGill University, Montréal, QC H4A 3J1, Canada
| | - Leila Cattelan
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, QC H4A 3J1, Canada; (F.L.)
| | - Jonathan LeBeau
- Department of Medicine, Faculty of Medicine and Health Sciences, McGill University, Montréal, QC H4A 3J1, Canada
| | - Joël Claveau
- Centre Hospitalier Universitaire de Québec, Hôtel-Dieu de Québec, Melanoma and Skin Cancer Clinic, Québec City, QC G1R 4H6, Canada
| | - Irina Turchin
- Division of Dermatology, Dalhousie University, Halifax, NS B3H 2Y9, Canada
| | - Wayne Gulliver
- Division of Dermatology, Department of Medicine, Memorial University of Newfoundland, St. John’s, NL A1C 5S7, Canada
| | - Robert Gniadecki
- Division of Dermatology, University of Alberta, Edmonton, AB T6G 2B7, Canada
| | - Elena Netchiporouk
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, QC H4A 3J1, Canada; (F.L.)
| | - Wilson H. Miller Jr.
- Department of Medicine and Oncology, McGill University, Montréal, QC H3T 1J4, Canada
| | - Thomas G. Salopek
- Division of Dermatology, University of Alberta, Edmonton, AB T6G 2B7, Canada
| | - Elham Rahme
- Division of Clinical Epidemiology, McGill University, Montréal, QC H3T 1J4, Canada
| | - Sandra Peláez
- École de Kinésiologie et des Sciences de L’activité Physique, Université de Montréal, Montréal, QC H3C 3J7, Canada;
| | - Ivan V. Litvinov
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, QC H4A 3J1, Canada; (F.L.)
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Leigh J, Qureshi D, Sucha E, Mahdavi R, Kushnir I, Lavallée LT, Bosse D, Webber C, Tanuseputro P, Ong M. A population-based study of factors associated with systemic treatment in advanced prostate cancer decedents. Cancer Med 2023; 12:5569-5579. [PMID: 36397730 PMCID: PMC10028120 DOI: 10.1002/cam4.5401] [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] [Received: 08/23/2022] [Revised: 10/13/2022] [Accepted: 10/23/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Life-prolonging therapies (LPTs) are rapidly evolving for the treatment of advanced prostate cancer, although factors associated with real-world uptake are not well characterized. METHODS In this cohort of prostate-cancer decedents, we analyzed factors associated with LPT access. Population-level databases from Ontario, Canada identified patients 65 years or older with prostate cancer receiving androgen deprivation therapy and who died of prostate cancer between 2013 and 2017. Univariate and multivariable analyses assessed the association between baseline characteristics and receipt of LPT in the 2 years prior to death. RESULTS Of 3575 patients who died of prostate cancer, 40.4% (n = 1443) received LPT, which comprised abiraterone (66.3%), docetaxel (50.3%), enzalutamide (17.2%), radium-223 (10.0%), and/or cabazitaxel (3.5%). Use of LPT increased by year of death (2013: 22.7%, 2014: 31.8%, 2015: 41.8%, 2016: 49.1%, and 2017: 57.9%, p < 0.0001), driven by uptake of all agents except docetaxel. Adjusted odds of use were higher for patients seen at Regional Cancer Centers (OR: 1.8, 95% CI: 1.5-2.1) and who received prior prostate-directed therapy (OR: 1.3, 95% CI: 1.0-1.5), but lower with advanced age (≥85: OR: 0.54, 95% CI:0.39-0.75), increased chronic conditions (≥6: OR: 0.62, 95% CI: 0.43-0.92), and long-term care residency (OR: 0.38, 95% CI: 0.17-0.89). Income, stage at presentation, and distance to the cancer center were not associated with LPT uptake. CONCLUSION In this cohort of prostate cancer-decedents, real-world uptake of novel prostate cancer therapies occurred at substantially higher rates for patients receiving care at Regional Cancer Centers, reinforcing the potential benefits for treatment access for patients referred to specialist centers.
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Affiliation(s)
- Jennifer Leigh
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Danial Qureshi
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Nuffield Department of Population Health, University of Oxford, England, UK
| | - Ewa Sucha
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- ICES University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Roshanak Mahdavi
- ICES University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Igal Kushnir
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Luke T Lavallée
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Division of Urology, Department of Surgery, The Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada
| | - Dominick Bosse
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Division of Medical Oncology, Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Colleen Webber
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Peter Tanuseputro
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- ICES University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Michael Ong
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Division of Medical Oncology, Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
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Silver JK, Santa Mina D, Bates A, Gillis C, Silver EM, Hunter TL, Jack S. Physical and Psychological Health Behavior Changes During the COVID-19 Pandemic that May Inform Surgical Prehabilitation: a Narrative Review. CURRENT ANESTHESIOLOGY REPORTS 2022; 12:109-124. [PMID: 35194411 PMCID: PMC8855650 DOI: 10.1007/s40140-022-00520-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2022] [Indexed: 12/23/2022]
Abstract
Purpose of Review Multimodal prehabilitation aims to improve preoperative health in ways that reduce surgical complications and expedite post-operative recovery. However, the extent to which preoperative health has been affected by the COVID-19 pandemic is unclear and evidence for the mitigating effects of prehabilitation in this context has not been elucidated. The COVID-19 pandemic has forced a rapid reorganization of perioperative pathways. Delayed diagnosis and surgery have caused a backlog of cases awaiting surgery increasing the risk of more complex procedures due to disease progression. Poor fitness and preoperative deconditioning are predictive of surgical complications and may be compounded by pandemic-related restrictions to accessing supportive services. The COVID-19 pandemic has forced a rapid reorganization of perioperative pathways. This narrative review aims to summarize the understanding of the effects of the COVID-19 pandemic on preoperative health and related behaviors and their implication for the need and delivery for prehabilitation to engender improved surgical outcomes. A literature search of Medline was conducted for articles related to preoperative health, prehabilitation, and surgical outcomes published between December 1, 2020 and January 31, 2021. Additional hand searches for relevant publications within the included literature were also conducted through October 15, 2021. Recent Findings The COVID-19 pandemic, and measures designed to reduce the spread of the virus, have resulted in physical deconditioning, deleterious dietary changes, substance misuse, and heightened anxiety prior to surgery. Due to the adverse health changes prior to surgery, and often protracted waiting time for surgery, there is likely an elevated risk of peri- and post-operative complications. A small number of prehabilitation services and research programmes have been rapidly adapted or implemented to address these needs. Summary During the COVID-19 pandemic to date, people undergoing surgery have faced a triple threat posed by extended wait times for surgery, reduced access to supportive services, and an elevated risk of poor outcomes. It is imperative that healthcare providers find ways to employ evidence-based prehabilitation strategies that are accessible and safe to mitigate the negative impact of the pandemic on surgical outcomes. Attention should be paid to cohorts most affected by established health inequities and further exacerbated by the pandemic.
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Affiliation(s)
- Julie K. Silver
- Harvard Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, 55 Fruit Street, Boston, MA USA
| | - Daniel Santa Mina
- Faculty of Kinesiology and Physical Education, The University of Toronto, 55 Harbord St, Toronto, ON M5S 2W6 Canada
| | - Andrew Bates
- NIHR Southampton Biomedical Research Centre, Critical Care Research, University Hospital, Tremona Road, Southampton, SO16 6YD UK
| | - Chelsia Gillis
- School of Human Nutrition, McGill University, QC, Canada
| | - Emily M. Silver
- Department of Psychology and Integrative Neuroscience Program, The University of Chicago, Chicago, IL USA
| | - Tracey L. Hunter
- Department of Internal Medicine, Kaiser Permanente Oakland Medical Center, Oakland, CA USA
| | - Sandy Jack
- NIHR Southampton Biomedical Research Centre, Critical Care Research, University Hospital, Tremona Road, Southampton, SO16 6YD UK
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Li W, Xu X, Zhang Y. Novel Prognostic Models Predicting the Cancer-Specific Survival in Patients with Cutaneous Melanoma Based on Metastatic Lymph Node Status. Ann Surg Oncol 2021; 28:4572-4581. [PMID: 33432490 DOI: 10.1245/s10434-020-09556-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 12/17/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND In cutaneous melanoma (CM), the present methods of lymph node (LN) staging have not sufficiently utilized the prognostic information of metastatic LNs. In this study, we aimed to construct prognostic nomograms based on the number of positive LNs (PLNs) and other clinicopathologic characteristics of CM patients. METHODS Two prognostic models were constructed in the none/single PLN (PLNnone/single) and multiple PLN (PLNmultiple) cohorts, respectively. Independent prognostic predictors associated with cancer-specific survival (CSS) in the above two cohorts were integrated to construct two nomograms for predicting the probability of 2-, 4-, and 6-year CSS in the PLNnone/single and PLNmultiple cohorts. The nomograms were evaluated by the area under the receiver operating characteristic curves (AUC), the calibration plots, and the decision curve analyses (DCAs). RESULTS A total of 31,065 CM cases were included in this study. Factors included in the prognostic nomogram for patients in the PLNnone/single cohort were age, sex, race, marital status, insurance, primary tumor site, T stage, and number of PLNs, while factors included in the nomogram for cases in the PLNmultiple cohort included age, sex, marital status, insurance, primary tumor site, T stage, and number of PLNs. The AUC values for 2-, 4-, and 6-year CSS in the validation group of the PLNnone/single cohort were 0.833, 0.811, and 0.818, respectively, while in the validation group of the PLNmultiple cohort, the AUC values for 2-, 4,- and 6-year CSS were 0.720, 0.723, and 0.745, respectively. Compared with the American Joint Committee on Cancer 7th edition staging system, our two nomograms showed better predictive values. Additionally, the calibration plots and DCA curves for 2-, 4-, and 6-year CSS prediction demonstrated good coordination and net benefit in both the PLNnone/single and PLNmultiple cohorts. CONCLUSION Our nomograms, based on the number of PLNs and other clinicopathologic characteristics, showed good predictive ability for predicting the survival of CM patients.
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Affiliation(s)
- Wei Li
- Department of Plastic and Burns Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Xuewen Xu
- Department of Plastic and Burns Surgery, West China Hospital, Sichuan University, Chengdu, China.
| | - Yange Zhang
- Department of Plastic and Burns Surgery, West China Hospital, Sichuan University, Chengdu, China.
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