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Bangolo AI, Auda A, Bukasa-Kakamba J, Bhakta N, Dey S, lilhori A, Reddy G, Alqinai B, Sidiqui A, Sekhon I, Khatiashvili B, Abbas I, Kunnel S, Jarri A, Martinez E, Daoud D, Gupta I, Gompa H, Pender S, Aljaberi D, Aljanaahi H, Kunnel SS, Xiao Y, Jung Y, Nagpaul S, Naz A, Mallela T, Maung PM, Khalaf IY, Kim S, Alrestom R, Gajera A, Alkealy H, Kansal D, Dhall S, Satheesha S, Weissman S, Fwelo P. Interaction between tumor stage and age on survival outcomes of patients with anaplastic thyroid cancer. World J Exp Med 2024; 14:93869. [DOI: 10.5493/wjem.v14.i3.93869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 06/13/2024] [Accepted: 06/25/2024] [Indexed: 08/29/2024] Open
Abstract
BACKGROUND Anaplastic thyroid cancer (ATC) is an aggressive, rare malignancy associated with rapid growth and metastasis, and a very poor prognosis. We investigated the clinical characteristics, survival outcomes and independent prognostic factors associated with anaplastic thyroid cancer.
AIM To assess to what extent the interaction between age and tumor stage affects mortality.
METHODS A total of 622 patients diagnosed with anaplastic thyroid cancer, between 2010 and 2017 were enrolled in our study by retrieving data from the Surveillance, Epidemiology and End Results (SEER) database. We analyzed demographics, clinical characteristics, overall mortality (OM) and cancer specific mortality (CSM) of ATC. Variables with a P value < 0.1 were incorporated into the multivariate cox model to determine the independent prognostic factors. Furthermore, we analyzed the interaction between age and tumor stage on mortality.
RESULTS In the multivariate analyses, the divorced/separated population had a lower OM [hazard ratio (HR) = 0.63, 95%CI: 0.42-0.94, P < 0.05] and CSM (HR = 0.61, 95%CI: 0.40-0.92, P < 0.05). OM was higher in tumors with direct extension only (HR = 6.26, 95%CI: 1.29-30.42, P < 0.05) and tumors with distant spread (HR = 5.73, 95%CI: 1.34-24.51, P < 0.05). CSM was also higher in tumors with direct extension (HR = 5.05, 95%CI: 1.05-24.19, P < 0.05) and tumors with distant spread (HR = 4.57, 95%CI: 1.08-19.29, P < 0.05). Mortality was not adversely affected by lymph node involvement. OM was lower in patients who received radiation (HR = 0.66, 95%CI: 0.53-0.83, P < 0.01), chemotherapy (HR = 0.63, 95%CI: 0.50-0.79, P < 0.01) or surgery (HR = 0.53, 95%CI: 0.43-0.66, P < 0.01). CSM was also lower in patient who received radiation (HR = 0.64, 95%CI: 0.51-0.81, P < 0.01), chemotherapy (HR = 0.62, 95%CI: 0.50-0.78, P < 0.01) or surgery (HR = 0.51, 95%CI: 0.41-0.63, P < 0.01). There was no significant interaction between age and tumor stage that affected mortality.
CONCLUSION In this large US SEER database retrospective study, we found the mortality to be higher in advanced stage tumors with direct extension and distant metastasis. However, patients who received aggressive therapy showed a better overall survival. The aim of our study is to emphasize the importance of detecting ATC at an early stage and provide aggressive therapy to these patients. Since advanced stage ATC is associated with a dismal prognosis, we emphasize the need for randomized control trials and development of novel therapies that will be used to treat ATC.
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Affiliation(s)
- Ayrton I Bangolo
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Auda Auda
- Department of Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - John Bukasa-Kakamba
- Department of Endocrine and Metabolic Disorders, University of Kinshasa, Kinshasa Kinshasa, Congo
| | - Nayan Bhakta
- Department of Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Shraboni Dey
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Anupriya lilhori
- Department of Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Gowry Reddy
- Department of Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Budoor Alqinai
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Aman Sidiqui
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Imranjot Sekhon
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Barbare Khatiashvili
- Department of Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Iqra Abbas
- Department of Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Sandra Kunnel
- Department of Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Amer Jarri
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Emelyn Martinez
- Department of Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Deborah Daoud
- Department of Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Ishita Gupta
- Department of Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Harshini Gompa
- Department of Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Silvanna Pender
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Dana Aljaberi
- Department of Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Hamed Aljanaahi
- Department of Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Sandra S Kunnel
- Department of Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Yingxia Xiao
- Department of Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Yoontae Jung
- Department of Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Sneha Nagpaul
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Afshan Naz
- Department of Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Tejaswee Mallela
- Department of Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Phyo Maung Maung
- Department of Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Ibtihal Y Khalaf
- Department of Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Soobee Kim
- Department of Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Roua Alrestom
- Department of Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Aditya Gajera
- Department of Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Hiba Alkealy
- Department of Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Deepti Kansal
- Department of Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Sonam Dhall
- Department of Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Sanya Satheesha
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Simcha Weissman
- Department of Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Pierre Fwelo
- Department of Epidemiology, Human Genetics, and Environmental Sciences, UTHealth School of Public Health, Houston, TX 77030, United States
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2
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Drost LE, de Jong RDM, Stegeman M, Franx A, Vos MC. The influence of decisional conflict on treatment decision in pelvic organ prolapse-data from the SHADE-POP trial. Arch Gynecol Obstet 2024:10.1007/s00404-024-07723-8. [PMID: 39240322 DOI: 10.1007/s00404-024-07723-8] [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: 07/28/2024] [Accepted: 08/25/2024] [Indexed: 09/07/2024]
Abstract
PURPOSE Women with symptomatic pelvic organ prolapse are facing the choice between several treatment options and a potentially difficult decision. The aim of this study was to examine the effect of decisional conflict, patient characteristics and other decision-related factors on treatment decision in women with pelvic organ prolapse. METHODS Data from the SHADE-POP trial were used. Women with symptomatic pelvic organ prolapse who visited their gynaecologist for (new) treatment options were included. In all participants, demographical characteristics and validated questionnaires concerning decisional conflict (DCS), shared decision making (SDM-Q-9), information provision (SCIP-B), anxiety and depression (HADS) and satisfaction with care (PSQ-18) were collected 2 weeks after the visit. Analyses were performed using univariate and multivariate linear and logistic regression analyses. RESULTS Ninety six women with pelvic organ prolapse facing a treatment decision were included. An increase in decisional conflict as experienced by patients was related to the choice of more conservative treatment, such as pelvic floor muscle training or pessary, instead of surgery (p = 0.02). Shared decision making, better information provision and satisfaction with care were related to lower levels of decisional conflict (p = 0.001). CONCLUSION Decisional conflict in women with pelvic organ prolapse favours conservative treatment instead of surgery. Gaining knowledge on the effect of decisional conflict, patient characteristics and other decision-related factors on treatment decision in pelvic organ prolapse will be a step towards a better-guided treatment decision and better patient-reported outcomes for this group of patients. NL 55737.028.15, 30-10-2016.
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Affiliation(s)
- Larissa E Drost
- Department of Obstetrics and Gynaecology, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands.
- Department of Obstetrics and Gynaecology, Erasmus Medical Center, Rotterdam, The Netherlands.
| | - Rachel D M de Jong
- Department of Obstetrics and Gynaecology, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
| | - Marjan Stegeman
- Department of Obstetrics and Gynaecology, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
| | - Arie Franx
- Department of Obstetrics and Gynaecology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - M Caroline Vos
- Department of Obstetrics and Gynaecology, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
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Mani K, Kleinbart E, Schlumprecht A, Golding R, Akioyamen N, Song H, De La Garza Ramos R, Eleswarapu A, Yang R, Geller D, Hoang B, Yassari R, Fourman MS. Area Socioeconomic Status is Associated with Refusal of Recommended Surgery in Patients with Metastatic Bone and Joint Disease. Ann Surg Oncol 2024; 31:4882-4893. [PMID: 38861205 PMCID: PMC11236857 DOI: 10.1245/s10434-024-15299-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 04/01/2024] [Indexed: 06/12/2024]
Abstract
BACKGROUND This study sought to identify associations between the Yost Index, a geocoded area neighborhood socioeconomic status (nSES) score, and race/ethnicity with patient refusal of recommended surgery for metastatic bone disease. METHODS Patients with metastatic bone disease were extracted from the Surveillance, Epidemiology, and End Results database. The Yost Index was geocoded using factor analysis and categorized into quintiles using census tract-level American Community Service (ACS) 5-year estimates and seven nSES measures. Multivariable logistic regression models calculated odds ratios (ORs) of refusal of recommended surgery and 95% confidence intervals (CIs), adjusting for clinical covariates. RESULTS A total of 138,257 patients were included, of which 14,943 (10.8%) were recommended for surgical resection. Patients in the lowest nSES quintile had 57% higher odds of refusing surgical treatment than those in the highest quintile (aOR = 1.57, 95% CI 1.30-1.91, p < 0.001). Patients in the lowest nSES quintile also had a 31.2% higher age-adjusted incidence rate of not being recommended for surgery compared with those in the highest quintile (186.4 vs. 142.1 per 1 million, p < 0.001). Black patients had 34% higher odds of refusing treatment compared with White patients (aOR = 1.34, 95% CI 1.14-1.58, p = 0.003). Advanced age, unmarried status, and patients with aggressive cancer subtypes were associated with higher odds of refusing surgery (p < 0.001). CONCLUSIONS nSES and race/ethnicity are independent predictors of a patient refusing surgery for metastatic cancer to bone, even after adjusting for various clinical covariates. Effective strategies for addressing these inequalities and improving the access and quality of care of patients with a lower nSES and minority backgrounds are needed.
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Affiliation(s)
- Kyle Mani
- Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Anne Schlumprecht
- Department of Neurological Surgery, Montefiore Einstein, Bronx, NY, USA
| | | | - Noel Akioyamen
- Department of Orthopedic Surgery, Montefiore Einstein, Montefiore Medical Center, Bronx, NY, USA
| | - Hyun Song
- Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Ananth Eleswarapu
- Department of Orthopedic Surgery, Montefiore Einstein, Montefiore Medical Center, Bronx, NY, USA
| | - Rui Yang
- Department of Orthopedic Surgery, Montefiore Einstein, Montefiore Medical Center, Bronx, NY, USA
| | - David Geller
- Department of Orthopedic Surgery, Montefiore Einstein, Montefiore Medical Center, Bronx, NY, USA
| | - Bang Hoang
- Department of Orthopedic Surgery, Montefiore Einstein, Montefiore Medical Center, Bronx, NY, USA
| | - Reza Yassari
- Department of Neurological Surgery, Montefiore Einstein, Bronx, NY, USA
| | - Mitchell S Fourman
- Department of Orthopedic Surgery, Montefiore Einstein, Montefiore Medical Center, Bronx, NY, USA.
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Piątek S, Szymusik I, Bidziński M. Reproductive Results in Cancer Survivors after Fertility Sparing Management: The Need for the Standardization of Definitions. Cancers (Basel) 2023; 15:3569. [PMID: 37509232 PMCID: PMC10377228 DOI: 10.3390/cancers15143569] [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: 05/19/2023] [Revised: 06/14/2023] [Accepted: 07/06/2023] [Indexed: 07/30/2023] Open
Abstract
In fertility-sparing management (FSM), two different issues can be distinguished: the risk of recurrence/death and the chance of childbearing. Survival is the principal outcome in oncology, and definitions of overall survival and progression-free survival are therefore well defined and widely accepted. The introduction of FSM to clinical practice was determined by the desire of young cancer patients to still have children. Initially, in small groups of patients, any pregnancy and/or childbirth were considered successes. Nowadays, FSM occupies an important place in cancer treatment, with thousands of young women treated successfully. However, in contrast to survival, no definition has been established for evaluating the reproductive outcomes of FSM. This review article evaluates the current pregnancy and birth rates of cancer patients. Differences between fertility-sparing and conservative treatment are analyzed, and improper and confusing interchangeable applications of these terms are pointed out. Additionally, various reasons for choosing FSM as a treatment method-which are not directly related to fertility preservation (treatment mismatch)-are presented. Uniform definitions of reproduction after FSM should be established to enable the comparison of results and facilitate the counseling of patients regarding the chances of reproduction.
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Affiliation(s)
- Szymon Piątek
- Department of Gynecologic Oncology, The Maria Sklodowska-Curie National Research Institute of Oncology, 5 Roentgen Street, 02-781 Warsaw, Poland
- Kazimierz Pulaski University of Technology and Humanities in Radom, 26-600 Radom, Poland
| | - Iwona Szymusik
- Department of Obstetrics, Perinatology and Neonatology, Center of Postgraduate Medical Education, 80 Ceglowska Street, 00-001 Warsaw, Poland
| | - Mariusz Bidziński
- Department of Gynecologic Oncology, The Maria Sklodowska-Curie National Research Institute of Oncology, 5 Roentgen Street, 02-781 Warsaw, Poland
- Kazimierz Pulaski University of Technology and Humanities in Radom, 26-600 Radom, Poland
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5
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Butcher RL, Kinney LM, Blasdel GP, Elwyn G, Myers JB, Boh B, Luck KM, Moses RA. Decision making in metoidioplasty and phalloplasty gender-affirming surgery: a mixed methods study. J Sex Med 2023; 20:1032-1043. [PMID: 37173118 PMCID: PMC10311073 DOI: 10.1093/jsxmed/qdad063] [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: 11/20/2022] [Revised: 03/05/2023] [Accepted: 04/06/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Gender-affirming surgical procedures, such as metoidioplasty and phalloplasty for those assigned female at birth, are complex and multistaged and involve risks. Individuals considering these procedures experience greater uncertainty or decisional conflict, compounded by difficulty finding trustworthy information. AIM (1) To explore the factors contributing to decisional uncertainty and the needs of individuals considering metoidioplasty and phalloplasty gender-affirming surgery (MaPGAS) and (2) to inform development of a patient-centered decision aid. METHODS This cross-sectional study was based on mixed methods. Adult transgender men and nonbinary individuals assigned female at birth at various stages of MaPGAS decision making were recruited from 2 study sites in the United States to participate in semistructured interviews and an online gender health survey, which included measures of gender congruence, decisional conflict, urinary health, and quality of life. Trained qualitative researchers conducted all interviews with questions to explore constructs from the Ottawa decision support framework. OUTCOMES Outcomes included goals and priorities for MaPGAS, expectations, knowledge, and decisional needs, as well as variations in decisional conflict by surgical preference, surgical status, and sociodemographic variables. RESULTS We interviewed 26 participants and collected survey data from 39 (24 interviewees, 92%) at various stages of MaPGAS decision making. In surveys and interviews, affirmation of gender identity, standing to urinate, sensation, and the ability to "pass" as male emerged as highly important factors for deciding to undergo MaPGAS. A third of survey respondents reported decisional conflict. Triangulation of data from all sources revealed that conflict emerged most when trying to balance the strong desire to resolve gender dysphoria through surgical transition against the risks and unknowns in urinary and sexual function, appearance, and preservation of sensation post-MaPGAS. Insurance coverage, age, access to surgeons, and health concerns further influenced surgery preferences and timing. CLINICAL IMPLICATIONS The findings add to the understanding of decisional needs and priorities of those considering MaPGAS while revealing new complexities among knowledge, personal factors, and decisional uncertainty. STRENGTHS AND LIMITATIONS This mixed methods study was codeveloped by members of the transgender and nonbinary community and yielded important guidance for providers and individuals considering MaPGAS. The results provide rich qualitative insights for MaPGAS decision making in US contexts. Limitations include low diversity and sample size; both are being addressed in work underway. CONCLUSIONS This study increases understanding of the factors important to MaPGAS decision making, and results are being used to guide development of a patient-centered surgical decision aid and informed survey revision for national distribution.
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Affiliation(s)
- Rebecca L Butcher
- Center for Program Design and Evaluation, Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Hanover, NH 03755, United States
| | - Linda M Kinney
- Center for Program Design and Evaluation, Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Hanover, NH 03755, United States
| | - Gaines P Blasdel
- University of Michigan Medical School, Ann Arbor, MI 48109, United States
| | - Glyn Elwyn
- Coproduction Laboratory, Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Hanover, NH 03755, United States
| | - Jeremy B Myers
- Division of Urology, Department of Surgery, University of Utah Health, Salt Lake City, UT 84103, United States
| | - Benjamin Boh
- Affirm Endocrinology, Lebanon, NH 03766, United States
| | - Kaylee M Luck
- Section of Urology, Department of Surgery, Dartmouth Health, Lebanon, NH 03756, United States
| | - Rachel A Moses
- Section of Urology, Department of Surgery, Dartmouth Health, Lebanon, NH 03756, United States
- Geisel School of Medicine at Dartmouth, Hanover, NH 03755, United States
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Basmadjian RB, Chow K, Kim D, Kenney M, Lukmanji A, O'Sullivan DE, Xu Y, Quan ML, Cheung WY, Lupichuk S, Brenner DR. The Association between Early-Onset Diagnosis and Clinical Outcomes in Triple-Negative Breast Cancer: A Systematic Review and Meta-Analysis. Cancers (Basel) 2023; 15:cancers15071923. [PMID: 37046584 PMCID: PMC10093252 DOI: 10.3390/cancers15071923] [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: 03/06/2023] [Revised: 03/16/2023] [Accepted: 03/21/2023] [Indexed: 04/14/2023] Open
Abstract
Early-onset diagnosis, defined by age <40 years, has historically been associated with inferior outcomes in breast cancer. Recent evidence suggests that this association is modified by molecular subtype. We performed a systematic review and meta-analysis of the literature to synthesize evidence on the association between early-onset diagnosis and clinical outcomes in triple-negative breast cancer (TNBC). Studies comparing the risk of clinical outcomes in non-metastatic TNBC between early-onset patients and later-onset patients (≥40 years) were queried in Medline and EMBASE from inception to February 2023. Separate meta-analyses were performed for breast cancer specific survival (BCSS), overall survival (OS), and disease-free survival (DFS), locoregional recurrence-free survival (LRRFS), distant recurrence-free survival (DRFS), and pathological complete response (pCR). In total, 7581 unique records were identified, and 36 studies satisfied inclusion criteria. The pooled risk of any recurrence was significantly greater in early-onset patients compared to later-onset patients. Better BCSS and OS were observed in early-onset patients relative to later-onset patients aged >60 years. The pooled odds of achieving pCR were significantly higher in early-onset patients. Future studies should evaluate the role of locoregional management of TNBC and the implementation of novel therapies such as PARP inhibitors in real-world settings, and whether they improve outcomes.
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Affiliation(s)
- Robert B Basmadjian
- Department of Community Health Sciences, Foothills Medical Centre, University of Calgary, Calgary, AB T2N 2T9, Canada
| | - Kristian Chow
- Department of Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, AB T2N 4N2, Canada
| | - Dayoung Kim
- Department of Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, AB T2N 4N2, Canada
| | - Matthew Kenney
- Department of Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, AB T2N 4N2, Canada
| | - Aysha Lukmanji
- Department of Community Health Sciences, Foothills Medical Centre, University of Calgary, Calgary, AB T2N 2T9, Canada
| | - Dylan E O'Sullivan
- Department of Community Health Sciences, Foothills Medical Centre, University of Calgary, Calgary, AB T2N 2T9, Canada
- Department of Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, AB T2N 4N2, Canada
- Department of Cancer Epidemiology and Prevention Research, Cancer Research & Analytics, Cancer Care Alberta, Alberta Health Services, Calgary, AB T2S 3C3, Canada
| | - Yuan Xu
- Department of Community Health Sciences, Foothills Medical Centre, University of Calgary, Calgary, AB T2N 2T9, Canada
- Department of Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, AB T2N 4N2, Canada
- Department of Surgery, Foothills Medical Centre, University of Calgary, Calgary, AB T2N 2T9, Canada
| | - May Lynn Quan
- Department of Community Health Sciences, Foothills Medical Centre, University of Calgary, Calgary, AB T2N 2T9, Canada
- Department of Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, AB T2N 4N2, Canada
- Department of Surgery, Foothills Medical Centre, University of Calgary, Calgary, AB T2N 2T9, Canada
| | - Winson Y Cheung
- Department of Community Health Sciences, Foothills Medical Centre, University of Calgary, Calgary, AB T2N 2T9, Canada
- Department of Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, AB T2N 4N2, Canada
| | - Sasha Lupichuk
- Department of Community Health Sciences, Foothills Medical Centre, University of Calgary, Calgary, AB T2N 2T9, Canada
- Department of Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, AB T2N 4N2, Canada
| | - Darren R Brenner
- Department of Community Health Sciences, Foothills Medical Centre, University of Calgary, Calgary, AB T2N 2T9, Canada
- Department of Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, AB T2N 4N2, Canada
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7
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Raisi-Estabragh Z, Kobo O, Freeman P, Petersen SE, Kolman L, Miller RJH, Roguin A, Van Spall HGC, Vuong J, Yang EH, Mamas MA. Temporal trends in disease-specific causes of cardiovascular mortality amongst patients with cancer in the USA between 1999 and 2019. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2022; 9:54-63. [PMID: 35435219 PMCID: PMC9745666 DOI: 10.1093/ehjqcco/qcac016] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 04/06/2022] [Accepted: 04/11/2022] [Indexed: 12/15/2022]
Abstract
AIMS We report disease-specific cardiovascular causes of mortality among cancer patients in the USA between 1999 and 2019, considering temporal trends by age, sex, and cancer site. METHODS AND RESULTS We used the Multiple Cause of Death database, accessed through the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research resource. We included 629 308 decedents with cardiovascular disease (CVD) recorded as the primary cause of death and active malignancy listed as a contributing cause of death. We created disease-specific CVD categories and grouped cancers by site. We calculated the proportion of CVD deaths attributed to each disease category stratified by sex, age, and cancer site. We also examined disease-specific temporal trends by cancer site. Ischaemic heart disease (IHD) was the most common cardiovascular cause of death across all cancer types (55.6%), being more common in men (59.8%), older ages, and in those with lung (67.8%) and prostate (58.3%) cancers. Cerebrovascular disease (12.9%) and hypertensive diseases (7.6%) were other common causes of death. The proportion of deaths due to heart failure was greatest in haematological (7.7%) and breast (6.3%) cancers. There was a decreasing temporal trend in the proportion of cardiovascular deaths attributed to IHD across all cancer types. The proportion of deaths due to hypertensive diseases showed the greatest percentage increase, with the largest change in breast cancer patients (+191.1%). CONCLUSION We demonstrate differential cardiovascular mortality risk by cancer site and demographics, providing insight into the evolving healthcare needs of this growing high-cardiovascular risk population.
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Affiliation(s)
- Zahra Raisi-Estabragh
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
| | - Ofer Kobo
- Department of Cardiology, Hillel Yaffe Medical Center, Hadera, Israel
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Keele, UK
| | - Phillip Freeman
- Cardiology Department, Aalborg University Hospital, Hobrovej 18-22, 9100 Aalborg, Denmark
| | - Steffen E Petersen
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
- Health Data Research UK, London, UK
| | - Louis Kolman
- Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
| | | | - Ariel Roguin
- Department of Cardiology, Hillel Yaffe Medical Center, Hadera, Israel
| | - Harriette G C Van Spall
- Department of Health Research Methods, Evidence, and Impact, Department of Medicine, Population Health Research Institute, Research Institute of St. Joe's, McMaster University, Hamilton, ON, Canada
| | - Jacqueline Vuong
- UCLA Cardio-Oncology Program, Division of Cardiology, Department of Medicine, University of California, Los Angeles, CA, USA
| | - Eric H Yang
- UCLA Cardio-Oncology Program, Division of Cardiology, Department of Medicine, University of California, Los Angeles, CA, USA
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Keele, UK
- Department of Cardiology, Thomas Jefferson University, Philadelphia, PA, USA
- Institute of Population Health, University of Manchester, Manchester, UK
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Abstract
BACKGROUND Patients undergoing colectomy may be at risk for postoperative regret, which is associated with worse quality of life, higher rates of depression, and poorer health outcomes. A better understanding of factors associated with decisional regret may allow surgeons to better tailor preoperative discussions to mitigate the risk of regret. OBJECTIVE This study aimed to identify factors associated with regret in patients undergoing elective and urgent/emergent colectomy. DESIGN A retrospective cohort study. SETTING The Michigan Surgical Quality Collaborative, a 73-hospital collaborative, which collects clinical data on general surgery operations. PATIENTS Patients aged >18 years who underwent elective or urgent/emergent colectomy between January 2017 and March 2020 and who completed a decision regret survey. MAIN OUTCOME MEASURES Any degree of postoperative regret. RESULTS Of 3638 patients, 2,530 (70%) underwent elective and 1108 (30%) underwent urgent/emergent colectomy. Overall, 381 (10.5%) patients reported regret, with higher rates among the urgent/emergent setting compared with the elective cohort (13.0% vs 9.4%; p < 0.001). In the elective cohort, regret was associated with length of stay >7 days (OR, 2.32; 95% CI, 1.06-5.07), postoperative complication (OR, 1.95; 95% CI, 1.36-2.79), and readmission (OR, 1.90; 95% CI, 1.22-2.95). Elective colectomies for cancer/adenoma/polyp were associated with lower odds of regret (OR, 0.68; 95% CI, 0.50-0.91). In the urgent/emergent cohort, regret was associated with female sex (OR, 1.69; 95% CI, 1.15-2.50) and nonhome discharge destination (OR, 1.61; 95% CI, 0.04-1.03). LIMITATIONS Hospitals used different sampling strategies, limiting our ability to calculate a true response rate and characterize nonresponders. CONCLUSIONS One in 10 patients reported regret after colectomy with higher rates in those undergoing urgent/emergent colectomy. Factors associated with regret were different between surgical settings. Efforts are needed to mitigate patients' risk of regret with individualized discussions contingent on surgical settings to better align expectations and outcomes. See Video Abstract at http://links.lww.com/DCR/C3 . ARREPENTIMIENTO DEL PACIENTE EN LA DECISIN DE SOMETIMIENTO A COLECTOMA ANTECEDENTES:Los pacientes que se someten a una colectomía pueden estar en riesgo de arrepentimiento post operatorio, la cual está asociada con una peor calidad de vida, mayores tasas de depresión y peores resultados de salud. Una mejor comprensión de los factores asociados con el arrepentimiento de dicha decisión, puede permitir a los cirujanos adaptar de una mejor manera las discusiones preoperatorias y así mitigar el riesgo de arrepentimiento.OBJETIVO:Identificar factores asociados al arrepentimiento en pacientes sometidos a colectomía electiva y urgente/emergente.DISEÑO:Estudio de cohorte retrospectivo.ESCENARIO:The Michigan Surgical Quality Collaborative, una colaboración de 73 hospitales.PACIENTES:Pacientes ≥18 años sometidos a colectomía electiva o urgente/emergente entre enero de 2017 y marzo de 2020, y que hayan completado una encuesta de arrepentimiento en cuanto a la decisión.PRINCIPALES MEDIDAS DE RESULTADO:Reporte de cualquier grado de arrepentimiento postoperatorio.RESULTADOS:De 3.638 pacientes, 2.530 (70%) fueron sometidos a colectomía electiva y 1.108 (30%) a colectomía urgente/emergente. En general, 381 (10,5%) pacientes informaron arrepentimiento, con tasas más altas en el grupo relacionado con el escenario urgente/emergente en comparación con la cohorte electiva (13,0% frente a 9,4%, p < 0,001). En la cohorte electiva, el arrepentimiento se asoció con una estancia hospitalaria >7 días (OR 2,32, IC 95% 1,06-5,07), complicación posoperatoria (OR 1,95, IC 95% 1,36-2,79) y reingreso (OR 1,90, IC 95% 1,22-2,95). Las colectomías electivas por cáncer/adenoma/pólipo se asociaron con una menor probabilidad de arrepentimiento (OR 0,68, IC 95%: 0,50-0,91). En la cohorte urgente/emergente, el arrepentimiento se asoció con el sexo femenino (OR 1,69, IC 95% 1,15-2,50) y el destino del alta no domiciliario (OR 1,61, IC 95% 0,04-1,03).LIMITACIONES:Los hospitales utilizaron diferentes estrategias de muestreo, lo que limita nuestra capacidad para calcular una tasa de respuesta real y caracterizar a los que no respondieron.CONCLUSIONES:Uno de cada diez pacientes reportó arrepentimiento después de la colectomía con tasas más altas en aquellos sometidos a colectomía urgente/emergente. Los factores asociados con el arrepentimiento fueron diferentes entre los entornos quirúrgicos. Se necesitan esfuerzos para mitigar el riesgo de arrepentimiento de los pacientes con discusiones individualizadas supeditadas al entorno quirúrgico para caracterizar de una mejor las expectativas y los resultados. Consulte Video Resumen en http://links.lww.com/DCR/C3 . (Traducción-Dr. Osvaldo Gauto).
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Health-related quality of life among breast cancer patients in India. Support Care Cancer 2022; 30:9983-9990. [PMID: 36222977 DOI: 10.1007/s00520-022-07395-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 10/04/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE This study evaluated the health-related quality of life (HRQoL) among breast cancer patients during various phases of treatment and with different treatment modalities, which helps in monitoring treatment outcomes, assessing the well-being of patients, and conducting health technology assessments. METHODS A total of 534 interviews were conducted among the patients of breast cancer recruited at different stages of disease and with different treatment modalities. HRQoL was determined using EuroQoL five dimensions questionnaire with five levels (EQ-5D-5L), EuroQoL Visual Analogue Scale (EQ VAS), and the EORTC QLQ-BR23 instrument. The utility values were determined based on the Indian EQ-5D-5L value set. The socio-demographic and clinico-therapeutic determinants of HRQoL were evaluated using multiple linear regression. RESULTS The mean utility value of breast cancer patients was 0.602 (SD = 0.311) and mean EQ VAS score was 75 (SD = 12.3). The mean utility value at diagnosis was 0.628, whereas utility value was 0.55, 0.595, and 0.64 for post-surgery, post-chemotherapy, and post-radiotherapy treatment groups, respectively. The most frequently reported problem was pain/discomfort (in 84.3% patients), followed by anxiety/depression (83.5%). On EORTC QLQ-BR23, the maximum symptom scale scores for systemic therapy side effects were reported in the post chemotherapy group. The body image score and future perspective score were better in patients undergoing breast conservative surgery (BCS) compared to patients undergoing modified radical mastectomy. Age, education, and employment status of the patient, type of treatment modality, and use of taxanes are the determinants of HRQoL in breast cancer patients. CONCLUSION Clinical interventions should focus upon management of pain and anxiety. BCS should be offered to all eligible patients as it is associated with better HRQoL. Addressing the factors that independently affect the HRQoL will help in improving the treatment compliance and outcomes.
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The influence of cross-regional medical treatment on total medical expenses, medical insurance payments, and out-of-pocket expenses of patients with malignant tumors in Chinese low-income areas. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2022; 20:35. [PMID: 35864496 PMCID: PMC9306213 DOI: 10.1186/s12962-022-00368-x] [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: 03/02/2022] [Accepted: 07/05/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND In recent years, due to the increasing number of cross-regional medical patients, countries around the world have issued a series of policies or regulations to reduce their out-of-pocket burden. In this context, this study intended to explore the impact of the Spatio-temporal characteristics of cross-regional medical treatment on total medical expenses, medical insurance payments, and out-of-pocket expenses of patients with malignant tumors in low-income areas. METHODS This study included 54,904 data of cross-provincial medical treatment of malignant tumor patients insured in Heilongjiang Province, China in 2020. Firstly, Microsoft Excel 2019 and ArcGIS 10.2 were applied to conduct a descriptive analysis of the Spatio-temporal characteristics of their cross-provincial medical treatment. Then, binary and multivariate logistic regression models were used to explore the specific impact of economic level and geographical distance of medical regions on total medical expenses, medical insurance payments, and out-of-pocket expenses. RESULTS The number of cross-regional medical patients showed a gradual upward trend from February to December, and fell back in January. They were concentrated in regions with high economic level and short distance from the insured region, where were more likely to form the group with high out-of-pocket expenses (AOR = 3.620, P < 0.001; AOR = 1.882, P < 0.001). While this possibility in middle-distance medical regions were less (AOR = 0.545, P < 0.001). Afterwards, two sensitivity analysis methods showed that the results were robust. CONCLUSION The number of cross-regional medical patients with malignant tumors in low-income areas is affected by seasonal factors, meanwhile, their total medical expenses, actual medical insurance payment levels, and out-of-pocket expenses are all affected by the economic level and geographical distance of medical regions. And the middle-distance medical regions may be the best choice for patients with planned cross-regional medical treatment. These provide some evidence for policymakers to improve the fairness and sustainability of medical security for cross-regional medical patients and reduce their direct economic burden of disease.
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11
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Chuang MH, Chen JY, Tsai WW, Lee CW, Lee MC, Tseng WH, Hung KC. Impact of comprehensive geriatric assessment on the risk of adverse events in the older patients receiving anti-cancer therapy: a systematic review and meta-analysis. Age Ageing 2022; 51:6625706. [PMID: 35776674 DOI: 10.1093/ageing/afac145] [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: 02/24/2022] [Revised: 04/26/2022] [Accepted: 06/01/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND to assess the efficacy of comprehensive geriatric assessment (CGA) for preventing treatment-related toxicity in older people undergoing non-surgical cancer therapies. METHODS MEDLINE, EMBASE and Cochrane library databases were searched from inception till January 2022 to identify randomised controlled trials (RCTs) on the incidence of toxicity measured by the Common Terminology Criteria for Adverse Events (primary outcome) and that of therapeutic modifications, early treatment discontinuation, progression-free survival, overall survival and hospitalisation (secondary outcomes). RESULTS analysis of six RCTs published from 2016 to 2021 recruiting 2,126 participants (median age: 71-77) who received chemotherapy as the major therapeutic approach revealed 51.7% and 64.7% of Grade 3+ toxicity in the CGA and control (i.e. standard care) groups, respectively (RR = 0.81, 95% CI: 0.7-0.94, P = 0.005, I2 = 65%, certainty of evidence [COE]: moderate). There were no significant differences in the incidence of early treatment discontinuation (RR = 0.88, P = 0.47; I2 = 63%,1,408 participants, COE: low), initial reduction in treatment intensity (RR = 0.99, P = 0.94; I2 = 83%, 2055 participants, COE: low), treatment delay (RR = 1.06, P = 0.77, I2 = 0%, 309 participants, COE: moderate), hospitalisation (RR = 0.86, P = 0.39, I2 = 41%, 914 participants, COE: moderate), progression-free and overall survival with or without CGA. However, there was an association between CGA and a lower incidence of dose reduction during treatment (RR = 0.73, P < 0.00001, 956 participants, COE: moderate). CONCLUSIONS our results demonstrated that comprehensive geriatric assessment may be associated with a lower incidence of treatment-related toxicity and dose reduction compared to standard care in older people receiving non-surgical cancer treatments. Further large-scale studies are warranted to support our findings.
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Affiliation(s)
- Min-Hsiang Chuang
- Department of Internal Medicine, Chi Mei Medical Center, Tainan City, Taiwan
| | - Jui-Yi Chen
- Division of Nephrology, Department of Internal Medicine, Chi Mei Medical Center, Tainan City, Taiwan.,Department of Health and Nutrition, Chia Nan University of Pharmacy and Science, Tainan City, Taiwan
| | - Wen-Wen Tsai
- Department of Education, Chi Mei Medical Center, Tainan City, Taiwan
| | - Chia-Wei Lee
- Department of Neurology, Chi-Mei Medical Center, Tainan City, Taiwan
| | - Mei-Chuan Lee
- Department of Pharmacy, Chi Mei Medical Center, Tainan City, Taiwan.,Department of Public Health, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
| | - Wen-Hsin Tseng
- Division of Urology, Department of Surgery, Chi Mei Medical Center, Tainan City, Taiwan
| | - Kuo-Chuan Hung
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan.,Department of Hospital and Health Care Administration, College of Recreation and Health Management, Chia Nan University of Pharmacy and Science, Tainan City, Taiwan
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12
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Lam K, Nazarian S, Gadi N, Hakky S, Moorthy K, Tsironis C, Ahmed A, Kinross JM, Purkayastha S. PATIENT PERSPECTIVES ON SURGEON-SPECIFIC OUTCOME REPORTS IN BARIATRIC SURGERY. Surg Obes Relat Dis 2022; 18:704-713. [DOI: 10.1016/j.soard.2022.02.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 02/03/2022] [Accepted: 02/27/2022] [Indexed: 02/06/2023]
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13
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Deliere A, Attai D, Victorson D, Kuchta K, Pesce C, Kopkash K, Sisco M, Seth A, Yao K. Patients Undergoing Bilateral Mastectomy and Breast-Conserving Surgery Have the Lowest Levels of Regret: The WhySurg Study. Ann Surg Oncol 2021; 28:5686-5697. [DOI: 10.1245/s10434-021-10452-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 06/08/2021] [Indexed: 12/23/2022]
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14
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Xiao L, Peng M, Liu Y, Zhang L. Information, deliberation, and decisional control preferences for participation in medical decision-making and its influencing factors among Chinese cancer patients. Health Expect 2021; 24:1725-1736. [PMID: 34309132 PMCID: PMC8483183 DOI: 10.1111/hex.13312] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/29/2021] [Accepted: 06/20/2021] [Indexed: 11/29/2022] Open
Abstract
Background Patient‐centred care should strive to respond to the individual patient's needs and preferences when possible. Yet, preferences of cancer patients for participation in different stages of the medical decision‐making process to increase matching of preferred and actual participation of the patients in decision‐making are not well known. Objective This study aimed to determine the level of information, deliberation and decisional control preferences in decision‐making practices among Chinese cancer patients and to explore their association with the sociodemographic and clinical variables of the patients. Methods A cross‐sectional study was conducted involving a convenience sample of 328 cancer patients from three public hospitals in Guangzhou, China. The Patient Expectation for Participation in Medical Decision‐making Scale (PEPMDS) was used to evaluate information, deliberation and decisional control preferences of the patients. Binary logistic regressions were conducted to determine the association between sociodemographic variables, clinical variables and preferences of the patients. Results Most patients reported a high preference for information (73.2%) and deliberation (73.8%), while a small number (37.2%) reported a high preference for decisional control. Younger patients and patients with higher levels of education were significantly more likely to have a high preference for information, deliberation and decisional control. Patients with low annual family incomes were significantly more likely to have a low preference for decisional control. Conclusion Preferences of patients for involvement in different stages of decision‐making practices could vary. The level of preferences appears to be related to the patient's age, education level, and financial status. Practice Implications Healthcare providers should tailor the participatory approaches of patients considering individual preferences for information, deliberation and decisional control during medical decision‐making. Patient Contribution Patients participated in the survey and filled in the questionnaires.
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Affiliation(s)
- Lin Xiao
- Evidence-based Nursing and Midwifery Practice Center, School of Nursing, Southern Medical University, Guangzhou, China
| | - Meifang Peng
- Department of Medical Oncology, Affiliated Cancer Hospital and Institute of Guangzhou Medical University, Guangzhou, Guangdong Province, China
| | - Yawei Liu
- Evidence-based Nursing and Midwifery Practice Center, School of Nursing, Southern Medical University, Guangzhou, China
| | - Lili Zhang
- Evidence-based Nursing and Midwifery Practice Center, School of Nursing, Southern Medical University, Guangzhou, China
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15
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Impact of Time to Initiation of Treatment on the Quality of Life of Women with Breast Cancer. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228325. [PMID: 33187071 PMCID: PMC7696805 DOI: 10.3390/ijerph17228325] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 11/07/2020] [Accepted: 11/09/2020] [Indexed: 12/31/2022]
Abstract
Introduction: Breast cancer is the most common malignancy in women. Due to the large number of women living with breast cancer and the increasing incidence of this cancer, it is very important to understand the factors determining the quality of life (QOL) of patients. The aim of the study. The aim of the study was to determine the impact of time to initiation of treatment on the quality of life of women with breast cancer. Materials and methods. The study involved 324 women with breast cancer, treated at the Podkarpackie Oncology Centre in Brzozów, Poland. The study was conducted using a diagnostic survey, using a standardised questionnaire to measure the quality of life of women treated for breast cancer, i.e., the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC) QLQ-C30 and the QLQ-BR23 module, as well as a proprietary survey questionnaire. Statistical analysis was performed using the Statistica 10.0 software (StatSoft Inc., 2011). A p value of <0.05 was considered statistically significant. Results: The examined women had a reduced overall quality of life and health (M = 53.88). The quality of life was higher in women who consulted a doctor the earliest after noticing initial symptoms of the disease, i.e., up to one week (M = 57.58), compared to patients who delayed the decision (over four weeks; M = 47.8) (p = 0.002). The quality of life was also considered higher by women who received treatment within two weeks of diagnosis (M = 56.79) and was lower for patients who waited for treatment for more than two months (M = 43.68). Statistically significant relationships were demonstrated for functional scales and disease intensity. Conclusions: Women diagnosed with breast cancer had a considerably lower overall quality of life. A relatively higher quality of life was experienced by patients who consulted a doctor the earliest after discovering symptoms of the disease and those whose waiting time for treatment was shorter. In a systematic manner, the individual stages of diagnosis should be maximally reduced and breast cancer treatment initiated without delay.
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Meattini I, Poortmans PMP, Marrazzo L, Desideri I, Brain E, Hamaker M, Lambertini M, Miccinesi G, Russell N, Saieva C, Strnad V, Visani L, Kaidar-Person O, Livi L. Exclusive endocrine therapy or partial breast irradiation for women aged ≥70 years with luminal A-like early stage breast cancer (NCT04134598 - EUROPA): Proof of concept of a randomized controlled trial comparing health related quality of life by patient reported outcome measures. J Geriatr Oncol 2020; 12:182-189. [PMID: 32739355 DOI: 10.1016/j.jgo.2020.07.013] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 04/21/2020] [Accepted: 07/18/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND Postoperative radiation therapy after breast conserving surgery in the older adult population is a matter of debate; although radiation therapy was shown to benefit these patients concerning local disease control, the absolute benefit was small and potentially negligible. Partial breast irradiation has been introduced as an alternative treatment approach for low-risk patients. Older adult patients with early breast cancer constitute a unique population with regards to prognosis and potential comorbidities, thus minimizing treatment to maintain health-related quality of life (HRQoL) without compromising survival is extremely important. Estimates of the patient's risk of benefit and/or harm with treatment should be performed together with an assessment of baseline comorbidities, life expectancy, and care preferences. Published data suggest that radiation therapy or endocrine therapy alone resulted in excellent disease control in older women with early breast cancer, and that the combination of both treatments has less incremental benefit than expected. Conversely, the toxicity profile of endocrine therapy is well known, often significantly impacting long term HRQoL of these potentially frail patients. METHODS Patients older than 70 years receiving breast conserving surgery with T1N0, Luminal A-like tumors will be randomized to receive partial breast irradiation-alone or endocrine therapy-alone. The main objectives are to determine patient reported outcome measures in terms of HRQoL, as assessed by the EORTC QLQ-C30 using the global health status of patients, and to demonstrate a non-inferior local control rate between arms. Secondary endpoints are represented by individual scales from QLQ-C30 and module QLQ-BR45 scores; ELD14 questionnaire; geriatric COre DatasEt assessment; distant control rate, adverse events rates, breast cancer specific, and overall survival. DISCUSSION The EUROPA trial is a new randomized trial focused on older adults (≥70 years) affected by good prognosis primary breast cancer. Our assumption is that postoperative radiation therapy-alone avoids the long-term toxicity of endocrine therapy and favorably impacts on HRQoL in this population. In the current report we present the trial's background and methods, focusing on perspectives in the field of precision medicine. TRIAL REGISTRATION The trial is registered with ClinicalTrial.gov Identifier NCT04134598 / EUROPA trial.
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Affiliation(s)
- Icro Meattini
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy; Azienda Ospedaliero Universitaria Careggi, Florence, Italy.
| | - Philip M P Poortmans
- Iridium Kankernetwerk, Wilrijk-Antwerp, Belgium; University of Antwerp, Faculty of Medicine and Health Sciences, Wilrijk-Antwerp, Belgium
| | - Livia Marrazzo
- Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Isacco Desideri
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy; Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Etienne Brain
- Institut Curie, Hopital René Huguenin, Saint-Cloud, France
| | | | - Matteo Lambertini
- Breast Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy; Department of Internal Medicine and Medical Specialties (DiMI), University of Genoa, Genoa, Italy
| | - Guido Miccinesi
- Istituto per lo Studio, la Prevenzione e la Rete Oncologica (ISPRO), Florence, Italy
| | - Nicola Russell
- The Netherland Cancer Institute, Amsterdam, the Netherlands
| | - Calogero Saieva
- Istituto per lo Studio, la Prevenzione e la Rete Oncologica (ISPRO), Florence, Italy
| | | | - Luca Visani
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy; Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | | | - Lorenzo Livi
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy; Azienda Ospedaliero Universitaria Careggi, Florence, Italy
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Anwar SL, Avanti WS, Nugroho AC, Choridah L, Dwianingsih EK, Harahap WA, Aryandono T, Wulaningsih W. Risk factors of distant metastasis after surgery among different breast cancer subtypes: a hospital-based study in Indonesia. World J Surg Oncol 2020; 18:117. [PMID: 32473643 PMCID: PMC7261382 DOI: 10.1186/s12957-020-01893-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 05/21/2020] [Indexed: 12/24/2022] Open
Abstract
Background More than one third of breast cancer patients including those that are diagnosed in early stages will develop distant metastasis. Patterns of distant metastasis and the associated risks according to the molecular subtypes are not completely revealed particularly in populations of patients with delayed diagnosis and advanced stages. Methods Breast cancer patients (n = 1304) admitted to our institute (2014–2017) were evaluated to identify the metastatic patterns and the associated risks. Metastatic breast cancers at diagnosis were found in 245 patients (18.7%), and 1059 patients were then grouped into non-metastatic and metastatic groups after a median follow-up of 3.8 years. Results Infiltration of the tumor to the skin and chest wall prevailed as the most powerful predictor for distant metastasis (OR 2.115, 95% CI 1.544–2.898) particularly in the luminal A-like subtype (OR 2.685, 95% CI 1.649–4.371). Nodal involvement was also significantly associated with the risk of distant metastasis (OR 1.855, 95% CI 1.319–2.611), and the risk was higher in the Luminal A-like subtype (OR 2.572, 95% CI 1.547–4.278). Luminal A-like subtype had a significant higher risk of bone metastasis (OR 1.601, 95% CI 1.106–2.358). In respect to treatment, a combination of anthracyclines and taxanes-based chemotherapy was significantly associated with lower distant organ spread in comparison with anthracycline-based chemotherapy (OR 0.510, 95% CI 0.355–0.766) and the effect was stronger in Luminal A-like subtype (OR 0.417, 95% CI 0.226–0.769). Classification into Luminal and non-Luminal subtypes revealed significant higher risks of bone metastasis in the Luminal subtype (OR 1.793, 95% CI 1.209–2.660) and pulmonary metastasis in non-Luminal breast cancer (OR 1.445, 95% CI 1.003–2.083). Conclusion In addition to guiding the treatment plan, a comprehensive analysis of clinicopathological variables including the molecular subtypes could assist in the determination of distant metastasis risks of breast cancer patients. Our study offers new perspectives concerning the risks of distant metastasis in breast cancer subtypes in order to plan intensive surveillance or escalation of treatment particularly in a setting where patients are predominantly diagnosed in late stages.
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Affiliation(s)
- Sumadi Lukman Anwar
- Division of Surgical Oncology, Department of Surgery, Dr Sardjito Hospital/Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Jl Kesehatan No. 1, Yogyakarta, 55281, Indonesia.
| | - Widya Surya Avanti
- Department of Radiology, Dr Sardjito Hospital/Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, 55281, Indonesia
| | - Andreas Cahyo Nugroho
- Division of Surgical Oncology, Department of Surgery, Dr Sardjito Hospital/Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Jl Kesehatan No. 1, Yogyakarta, 55281, Indonesia
| | - Lina Choridah
- Department of Radiology, Dr Sardjito Hospital/Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, 55281, Indonesia
| | - Ery Kus Dwianingsih
- Department of Anatomical Pathology, Dr Sardjito Hospital/Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, 55281, Indonesia
| | - Wirsma Arif Harahap
- Division of Surgical Oncology, Department of Surgery, Dr M Jamil Hospital/Faculty of Medicine, Universitas Andalas, Padang, 25127, Indonesia
| | - Teguh Aryandono
- Division of Surgical Oncology, Department of Surgery, Dr Sardjito Hospital/Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Jl Kesehatan No. 1, Yogyakarta, 55281, Indonesia
| | - Wahyu Wulaningsih
- MRC Unit for Lifelong Health and Ageing, University College London, Place London, Bedford 33, London, WC1B 5JU, UK
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Konieczny M, Cipora E, Sygit K, Fal A. Quality of Life of Women with Breast Cancer and Socio-Demographic Factors. Asian Pac J Cancer Prev 2020; 21:185-193. [PMID: 31983183 PMCID: PMC7294011 DOI: 10.31557/apjcp.2020.21.1.185] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Breast cancer treatment is an aggressive therapy that affects the deterioration of women's quality of life (QOL) in many areas. Knowledge about factors that influence the assessment of the QOL is of particular importance. The aim of the study was to analyse areas of the quality of life of women with breast cancer, taking into account social and demographic factors. METHODS The research was carried included 324 women with breast cancer. The research was carried out using a diagnostic survey, the author's questionnaire and a standardized questionnaire for measuring the QOL of women treated for breast cancer, ie the European Organization for Research and Treatment of Cancer, Quality of Life Questionnaire (EORTC) QLQ-C30 and QLQ-QLQ module BR23. Statistical analysis uses Statistica 10.0 software. The results were considered statistically significant when the calculated probability met the inequality of p.
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Affiliation(s)
- Magdalena Konieczny
- 1Jan Grodek State University in Sanok, Medical Institute, Mickiewicza 21, 38-500 Sanok, Poland
| | - Elżbieta Cipora
- 1Jan Grodek State University in Sanok, Medical Institute, Mickiewicza 21, 38-500 Sanok, Poland
| | - Katarzyna Sygit
- The President Stanisław Wojciechowski State University of Applied Sciences in Kalisz, Nowy Świat 4, 62-800 Kalisz, Poland
| | - Andrzej Fal
- Polish Public Health Association, Bartla 5, 51-618 Wrocław, Poland
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Scotté F, Bossi P, Carola E, Cudennec T, Dielenseger P, Gomes F, Knox S, Strasser F. Addressing the quality of life needs of older patients with cancer: a SIOG consensus paper and practical guide. Ann Oncol 2019; 29:1718-1726. [PMID: 30010772 DOI: 10.1093/annonc/mdy228] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Around 60% of people living with cancer are aged 65 years or older. Older cancer patients face a unique set of age-associated changes, comorbidities and circumstances that impact on their quality of life (QoL) in ways that are different from those affecting younger patients. A Task Force of the International Society of Geriatric Oncology recommends and encourages all healthcare professionals involved in cancer care to place greater focus on the QoL of older people living with cancer. This paper summarizes current thinking on the key issues of importance to addressing QoL needs of older cancer patients and makes a series of recommendations, together with practical guidance.
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Affiliation(s)
- F Scotté
- Department of Medical Oncology and Supportive Care, Foch Hospital, Suresnes, France.
| | - P Bossi
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - E Carola
- Groupe Hospitalier Public Sud de L'Oise, Creil, France
| | - T Cudennec
- Service de Médecine Gériatrique, HU-PIFO site Ambroise Paré, AP-HP, Boulogne Billancourt, France
| | - P Dielenseger
- Département des Innovations Thérapeutiques et Essais Précoces, Gustave Roussy Cancer Campus, French Oncology Nursing Society, Paris, France
| | - F Gomes
- Medical Oncology Department, The Christie Hospital NHS Foundation Trust, Manchester, UK
| | - S Knox
- EUROPA DONNA - The European Breast Cancer Coalition, Milan, Italy
| | - F Strasser
- Oncological Palliative Medicine, Clinic Medical Oncology and Hematology, Department of Internal Medicine, Cantonal Hospital St Gallen, St Gallen, Switzerland
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Prospective Long-Term Follow-Up of Pulmonary Diffusion Capacity Reduction Caused by Dose-Dense Chemotherapy in Patients with Breast Cancer. JOURNAL OF ONCOLOGY 2019; 2019:2584859. [PMID: 31772578 PMCID: PMC6854974 DOI: 10.1155/2019/2584859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Revised: 08/05/2019] [Accepted: 09/04/2019] [Indexed: 11/28/2022]
Abstract
Background Our previous study of pulmonary function in 34 patients with early breast cancer without preexisting lung disease showed that anthracycline- and taxane-based adjuvant dose-dense chemotherapy (DDC) caused a significant 16.4% mean reduction in carbon monoxide diffusing capacity (DLCO). The present study reports the pulmonary and oncological outcomes of these patients on long-term follow-up. Patients and methods The primary endpoint was DLCO measured by the pulmonary function test (PFT) performed at a median of 27 months after DDC (range, 8–97) in 25 patients without disease recurrence. DLCO values were recorded as a percentage of predicted values according to age, height, and hemoglobin level and analyzed relative to baseline pre-DDC DLCO values. The secondary endpoints were symptoms, additional therapies, and cancer outcomes during a median of 11 years' follow-up (range, 4.4–11.4). Results A longitudinal general linear model showed significant effects of time on DLCO and its trend (F(1, 87) = 14.68, p < 0.001 and F(1, 87) = 10.26, p=0.002, respectively). Complementary descriptive analysis showed a significant recovery on the follow-up PFT (75.6% vs. 81.9%, p=0.002), but it was still significantly lower than the baseline DLCO (81.9% vs. 92.0%, p=0.003). Five patients (20%) still showed a >20% relative DLCO reduction from baseline. Patients with dyspnea or fatigue at later clinical follow-up had a significantly lower DLCO value on the follow-up PFT than nonsymptomatic patients (80.5% vs. 92.1%, p=0.02). DLCO recovery was inversely correlated with age (R = −0.39, p=0.05), but no significant correlation was found with the length of time until the follow-up PFT or additional therapies. There was no association of DDC-related DLCO reduction with cancer outcomes. Conclusions The significant reduction in DLCO seen after DDC in patients with potentially curable breast cancer is evident years afterwards, especially in older patients. While most patients partly recover, some will have a lasting symptomatic DLCO impairment.
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Kugbey N, Meyer-Weitz A, Oppong Asante K. Mental adjustment to cancer and quality of life among women living with breast cancer in Ghana. Int J Psychiatry Med 2019; 54:217-230. [PMID: 30296866 DOI: 10.1177/0091217418805087] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE This study examined whether cancer-specific coping strategies have any significant influence on the quality of life of 205 women living with breast cancer in Ghana. METHODS Using a cross-sectional survey design, participants were administered questionnaires which measured their cancer-specific coping strategies and health-related quality of life. RESULTS Correlation analysis showed that helplessness-hopelessness negatively correlated with physical wellbeing, emotional wellbeing, functional wellbeing, and breast cancer additional concerns. Anxious preoccupation negatively correlated with all the domains of quality of life, whereas fighting spirit was positively correlated with emotional and functional wellbeing. Cognitive avoidance was positively correlated with functional wellbeing, while fatalism was positively related with all the domains of quality of life. Regression analysis revealed that anxious preoccupation predicted significant decreases in all the domains of quality of life, while helplessness-hopelessness predicted significant decreases in emotional and functional wellbeing domains. However, cognitive avoidance predicted significant increase in the functional domain of quality of life. CONCLUSION These findings underscore the need for psychosocial support for breast cancer patients to adopt effective coping strategies to deal with their challenges in managing their illness.
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Affiliation(s)
- Nuworza Kugbey
- 1 Discipline of Psychology, School of Applied Human Sciences, University of KwaZulu-Natal, Durban, South Africa.,2 Department of Family and Community Health, School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | - Anna Meyer-Weitz
- 1 Discipline of Psychology, School of Applied Human Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Kwaku Oppong Asante
- 1 Discipline of Psychology, School of Applied Human Sciences, University of KwaZulu-Natal, Durban, South Africa.,3 Department of Psychology, School of Social Sciences, University of Ghana, Accra, Ghana
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Tan EGF, Teo I, Finkelstein EA, Meng CC. Determinants of regret in elderly dialysis patients. Nephrology (Carlton) 2019; 24:622-629. [PMID: 29736929 DOI: 10.1111/nep.13400] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2018] [Indexed: 11/30/2022]
Abstract
AIMS In Singapore, most elderly end-stage renal disease (ESRD) patients choose dialysis over palliative management. However, dialysis may not be the optimal treatment option given only moderate survival benefits and high costs and treatment burden compared to non-dialysis management. Elderly patients may therefore come to regret this decision. This study investigated: (i) extent of patients' decision regret after starting dialysis, and (ii) potentially modifiable predictors of regret: satisfaction with chronic kidney disease education, decisional conflict, and decision-making involvement. METHODS The present study was a cross-sectional study of 103 dialysis patients above 70 years of age, surveyed at Singapore General Hospital's renal medicine clinics between March and June 2017. Participants reported their levels of decision regret on the Decision Regret Scale (DRS), retrospective decisional conflict on the Decisional Conflict Scale, information satisfaction, and decision-making involvement. RESULTS In total, 81% of participants reported no decision regret (DRS score < 50), 11% ambivalence (DRS = 50), and 8% regret (DRS >50). In individual DRS items, 19% felt dialysis had done them harm and 16% would not make the same decision again. In multivariable analyses, lower information satisfaction [b = -0.07 (95% CI: -0.13, -0.01)] and decisional conflict [b = 0.004 (95% CI: 0.002, 0.006)] were significantly associated with decision regret. CONCLUSION Although the majority of elderly dialysis patients were comfortable with their decision to start dialysis, a proportion was ambivalent or regretted this choice. Regret was more likely among those who experienced decisional conflict and/or expressed poorer information satisfaction. Healthcare professionals should recognize these risk factors and take steps to minimize chances of regret among this population subset.
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Affiliation(s)
- Edlyn G F Tan
- Doctor of Medicine (M.D.) Programme, Duke-NUS Medical School, Singapore
| | - Irene Teo
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore
| | | | - Chan C Meng
- Department of Renal Medicine, Singapore General Hospital, Singapore
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McClelland S, Kaleem T, Bernard ME, Ahmed HZ, Sio TT, Miller RC. The pervasive crisis of diminishing radiation therapy access for vulnerable populations in the United States-Part 4: Appalachian patients. Adv Radiat Oncol 2018; 3:471-477. [PMID: 30370344 PMCID: PMC6200890 DOI: 10.1016/j.adro.2018.08.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 07/31/2018] [Accepted: 08/02/2018] [Indexed: 12/17/2022] Open
Abstract
Purpose Compared with the rest of the United States, the population of Appalachia has lower education levels, higher rates of poverty, and limited access to health care. The presence of disparities in radiation therapy (RT) access for Appalachian patients with cancer has rarely been examined. Methods and materials The National Cancer Institute initiatives toward addressing disparities in treatment access for rural populations were examined. An extensive literature search was undertaken for studies investigating RT access disparities in Appalachian patients, beginning with the most common cancers in these patients (lung, colorectal, and cervical). Results Although the literature investigating RT access disparities in Appalachia is relatively sparse, studies examining lung, colorectal, cervical, prostate, head and neck, breast, and esophageal cancer, as well as lymphoma, indicate an unfortunate commonality in barriers to optimal RT access for Appalachian patients with cancer. These barriers are predominantly socioeconomic in nature (low income and lack of private insurance) but are exacerbated by paucities in both the number and quality of radiation centers that are accessible to this patient population. Conclusions Regardless of organ system, there are significant barriers for Appalachian patients with cancer to receive RT. Such diminished access is alarming and warrants resources devoted to addressing these disparities, which often go overlooked because of the assumption that the overall wealth of the United States is tangibly applicable to all of its citizens. Without intelligently targeted investments of time and finances in this arena, there is great risk of exacerbating rather than alleviating the already heavy burden facing Appalachian patients with cancer.
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Affiliation(s)
- Shearwood McClelland
- Department of Radiation Medicine, Oregon Health & Science University, Portland, Oregon
| | - Tasneem Kaleem
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida
| | - Mark E Bernard
- Department of Radiation Oncology, University of Kentucky, Lexington, Kentucky
| | - Hiba Z Ahmed
- Department of Radiation Oncology, Emory University, Atlanta, Georgia
| | - Terence T Sio
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona
| | - Robert C Miller
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida
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Ejem D, Dionne-Odom JN, Turkman Y, Knight SJ, Willis D, Kaufman PA, Bakitas M. Incongruence between women's survey- and interview-determined decision control preferences: A mixed methods study of decision-making in metastatic breast cancer. Psychooncology 2018; 27:1950-1957. [DOI: 10.1002/pon.4747] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 03/28/2018] [Accepted: 04/17/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Deborah Ejem
- School of Nursing; University of Alabama at Birmingham; Birmingham AL USA
| | | | - Yasemin Turkman
- School of Nursing; University of Alabama at Birmingham; Birmingham AL USA
| | - Sara J. Knight
- Department of Preventive Medicine; University of Alabama at Birmingham; Birmingham AL USA
| | - Dan Willis
- School of Nursing; University of Wisconsin-Madison; Madison WI USA
| | - Peter A. Kaufman
- Section of Hematology Oncology; Dartmouth-Hitchcock Medical Center; Lebanon NH USA
| | - Marie Bakitas
- School of Nursing; University of Alabama at Birmingham; Birmingham AL USA
- Department of Medicine; Division of Geriatrics, Gerontology, and Palliative Medicine; Birmingham AL USA
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Wilson A, Winner M, Yahanda A, Andreatos N, Ronnekleiv-Kelly S, Pawlik TM. Factors associated with decisional regret among patients undergoing major thoracic and abdominal operations. Surgery 2017; 161:1058-1066. [DOI: 10.1016/j.surg.2016.10.028] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 10/11/2016] [Accepted: 10/24/2016] [Indexed: 11/16/2022]
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Puty TC, Brito GSA, Dias MS, Miranda HC, Chaves JR, Freitas HL, Carvalho LEW. Complete and Sustained Response with a Doublet Chemotherapy Protocol in an 81-Year-Old Patient with Metastatic Breast Cancer. Case Rep Oncol 2016; 9:580-585. [PMID: 27920688 PMCID: PMC5118833 DOI: 10.1159/000449127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 08/15/2016] [Indexed: 11/25/2022] Open
Abstract
Metastatic breast cancer (MBC) entails an overall 5-year survival of approximately 25%. The choice of therapy is influenced by expression of the HER2 gene and hormone receptors, by a disease-free interval, and by age. The use of paclitaxel combined with gemcitabine (doublet protocol) has shown efficacy as first-line treatment for MBC in either initial or maintenance therapy when compared to monotherapy with paclitaxel. There is evidence showing that the doublet protocol is a good alternative to maintenance therapy in women under 50 years old. Nevertheless, there is a lack of information concerning individuals above that age. We report the case of an 81-year-old patient presenting with recurrence of MBC, with lung and skin metastases both positive for hormone receptor and negative for HER2. We implemented a therapy based on the combination of gemcitabine and paclitaxel for 12 cycles, when complete response was achieved. Currently, 16 months after this achievement, the patient is receiving maintenance treatment under the doublet protocol, presenting acceptable parameters of toxicity since the beginning of treatment, which shows satisfactory tolerability and management of chemotherapy in an elderly patient. We suggest that the maintenance treatment protocol with a doublet might be an alternative with a satisfactory response in patients with MBC.
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Affiliation(s)
- Taynah Cascaes Puty
- Oncológica Brazil - Education and Research, Belém, Brazil; Universidade do Estado do Pará, Belém, Brazil
| | - Gabriel S A Brito
- Oncológica Brazil - Education and Research, Belém, Brazil; Universidade Federal do Pará, Belém, Brazil
| | - Mariana S Dias
- Oncológica Brazil - Education and Research, Belém, Brazil; Universidade do Estado do Pará, Belém, Brazil
| | - Henrique C Miranda
- Oncológica Brazil - Education and Research, Belém, Brazil; Universidade do Estado do Pará, Belém, Brazil
| | - Juliana R Chaves
- Oncológica Brazil - Education and Research, Belém, Brazil; Hospital Oncológica Brasil, Belém, Brazil
| | | | - Luís E W Carvalho
- Oncológica Brazil - Education and Research, Belém, Brazil; Hospital Oncológica Brasil, Belém, Brazil
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Brennan ME, Flitcroft K, Warrier S, Snook K, Spillane AJ. Immediate expander/implant breast reconstruction followed by post-mastectomy radiotherapy for breast cancer: Aesthetic, surgical, satisfaction and quality of life outcomes in women with high-risk breast cancer. Breast 2016; 30:59-65. [DOI: 10.1016/j.breast.2016.08.008] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 07/27/2016] [Accepted: 08/17/2016] [Indexed: 11/25/2022] Open
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Krok-Schoen JL, Palmer-Wackerly AL, Dailey PM, Wojno JC, Krieger JL. Age Differences in Cancer Treatment Decision Making and Social Support. J Aging Health 2016; 29:187-205. [PMID: 26850474 DOI: 10.1177/0898264316628488] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The aim of this study was to examine the decision-making (DM) styles of younger (18-39 years), middle-aged (40-59 years), and older (≥60 years) cancer survivors, the type and role of social support, and patient satisfaction with cancer treatment DM. METHOD Adult cancer survivors ( N = 604) were surveyed using Qualtrics online software. RESULTS Older adults reported significantly lower influence of support on DM than younger adults. The most common DM style for the age groups was collaborative DM with their doctors. Younger age was a significant predictor of independent ( p < .05), collaborative with family ( p < .001), delegated to doctor ( p < .01), delegated to family ( p < .001), and demanding ( p < .001) DM styles. DISCUSSION Despite having lower received social support in cancer treatment DM, older adults were more satisfied with their DM than younger and middle-aged adults. Health care workers should be aware of different DM styles and influence of social networks to help facilitate optimal patient DM and satisfaction.
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Smith LI, Dayal S, Murray J, Lannigan A. Attitudes towards breast conservation in patients aged over 70 with breast cancer. SPRINGERPLUS 2016; 5:478. [PMID: 27217993 PMCID: PMC4835403 DOI: 10.1186/s40064-016-2133-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 04/08/2016] [Indexed: 11/25/2022]
Abstract
Background The majority of breast conserving surgery (BCS) is performed in younger women. There is little published information about the views of women aged over 70 regarding BCS. The aim of this study was to investigate the attitudes of this age group towards BCS, and factors which may influence their treatment decision-making. Methods A questionnaire was sent to all patients who were aged 70 or over at the time they had breast cancer surgery in NHS Lanarkshire between 1999 and 2013. This detailed surgical options and recommendations, timing of decision making, treatment expectations, psychological and cosmetic concerns and other factors which may have influenced any decision made e.g. travel for radiotherapy and potential side effects. Results Responses were received from 339 patients, 192 of whom had a mastectomy with the remaining undergoing BCS. In the mastectomy group 18 % (35) would have preferred to have BCS had it been an option, with 40 % (76) of group being happy to take neoadjuvant endocrine therapy to try and facilitate this. However, only 14 % (26) of patients would have considered neoadjuvant chemotherapy with the same aim. Almost half (82) of the mastectomy patients said that the risk of local recurrence following BCS was a factor which influenced their decision. Conclusion BCS is something that patients aged over 70 are interested in considering in the same way as younger patients. More than a third of patients requiring mastectomy would be willing to take neoadjuvant endocrine therapy to attempt to downstage their tumour to facilitate BCS.
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Affiliation(s)
- L I Smith
- Department of Breast Surgery, Wishaw General Hospital, 50 Netherton Street, Wishaw, ML2 0DP UK
| | - S Dayal
- Department of General Surgery, Basingstoke and North Hampshire Hospital, Aldermaston Road, Basingstoke, Hampshire RG24 9NA UK
| | - J Murray
- Department of Breast Surgery, Wishaw General Hospital, 50 Netherton Street, Wishaw, ML2 0DP UK
| | - A Lannigan
- Department of Breast Surgery, Wishaw General Hospital, 50 Netherton Street, Wishaw, ML2 0DP UK
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Becerra Pérez MM, Menear M, Brehaut JC, Légaré F. Extent and Predictors of Decision Regret about Health Care Decisions: A Systematic Review. Med Decis Making 2016; 36:777-90. [PMID: 26975351 DOI: 10.1177/0272989x16636113] [Citation(s) in RCA: 178] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 02/06/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND People often face difficult decisions about their health and may later regret the choice that they made. However, little is known about the extent of decision regret in health care or its predictors. We systematically reviewed evidence about the extent of decision regret and its risk factors among individuals making health decisions. METHODS The data sources were Medline, Embase, and reverse citation searches in Google Scholar and Web of Science. Studies using the Decision Regret Scale (DRS) to measure decision regret among individuals making nonhypothetical health decisions were included. There were no restrictions on study design, setting, or language. We extracted characteristics of included studies, measures of central tendency for DRS scores (0 = no regret, 100 = high regret), and all risk factors from published analyses. Quality appraisal was conducted using the Mixed Methods Appraisal Tool. A narrative synthesis was performed owing to the heterogeneity of studies. RESULTS The initial search yielded 372 unique titles, and 59 studies were included. The overall mean DRS score across studies was 16.5, and the median of the mean scores was 14.3 (standard deviation range = 2.2-34.5) (n = 44 studies). The risk factors most frequently reported to be associated with decision regret in multivariate analyses included higher decisional conflict, lower satisfaction with the decision, adverse physical health outcomes, and greater anxiety levels. CONCLUSIONS The extent of decision regret as assessed with the DRS in nonhypothetical health decisions was often low but reached high levels for some decisions. Several risk factors related to the decision-making process significantly predicted decision regret. Additional research into the psychometrics of the DRS and the relevance of scores for clinicians and patients would increase the validity of decision regret as a patient-reported outcome.
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Affiliation(s)
| | - Matthew Menear
- CHU de Québec Research Centre, Quebec City, Canada (MMBP, MM, FL),Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, Canada (MM, FL)
| | - Jamie C Brehaut
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada (JB),School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Canada (JB)
| | - France Légaré
- CHU de Québec Research Centre, Quebec City, Canada (MMBP, MM, FL),Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, Canada (MM, FL)
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Szutowicz-Wydra B, Wydra J, Kruszewski WJ, Ciesielski M, Szajewski M, Walczak J, Hansdorfer-Korzon R. Same Quality of Life for Polish Breast Cancer Patients Treated with Mastectomy and Breast Reconstruction or Breast-Conserving Therapy. POLISH JOURNAL OF SURGERY 2016; 88:264-269. [PMID: 27811351 DOI: 10.1515/pjs-2016-0062] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Indexed: 11/15/2022]
Abstract
AbstractBreast cancer often requires combined oncologic treatments, the base of which is surgery. Quality of life (QoL) after each surgical procedure may influence the process of decision making among women, who qualify for multiple oncological strategies. Our knowledge about QoL in breast cancer patients is derived from comparative studies. Results may differ, depending on country, culture, and societal relations.was to investigate the quality of life of Polish patients treated with breast-conserving therapy (BCT) or mastectomy with breast reconstruction.The study involved women who underwent surgery for breast cancer in the Department of Surgical Oncology of the Gdynia Oncology Center from September 2010 to November 2013. Eighty-two breast reconstructions (in 79 patients) and 226 BCT procedures were performed. QoL was measured with the use of EORTC QLQ-C30 and QLQ-BR23 questionnaires.Global QoL was high in both groups and did not differ significantly. Body image was slightly better after BCT than after mastectomy with breast reconstruction, but sexual QoL was lower. Future perspective was quite low in both groups. Disease symptoms were not bothering.The global QoL among Polish breast cancer patients treated with BCT or mastectomy with breast reconstruction is high and does not differ between groups. There is a need for anxiety and disease-related fear prophylaxis and for the improvement of sex life of breast cancer survivors.
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Pan HH, Chu CH, Wu LF, Hsieh PC, Chang KC, Li CY. Predictors for Reconstruction and Mood Disorder Associated With Reconstruction in Patients With Breast Cancer and Mastectomy: A Retrospective Cohort Study. Medicine (Baltimore) 2016; 95:e2510. [PMID: 26817890 PMCID: PMC4998264 DOI: 10.1097/md.0000000000002510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
This study used Taiwan's National Health Insurance medical claims to investigate the predictors for operative modes chosen by early-stage breast cancer patients; as well as to assess whether operative modes are associated with risk of mood disorder. We included 36,377 patients with breast cancer who received surgery between 2000 and 2008, and were followed to the end of 2010; they were further classified into 3 groups: mastectomy alone (n = 34,900), along with early reconstruction (n = 1080), and along with delayed reconstruction (n = 397). The results showed that age, insurance premium, urbanization level, and postsurgery chemotherapy and radiotherapy were all significant predictors for the selection of operative modes. Breast cancer patients with mastectomy alone, early reconstruction, and delayed reconstruction showed a cumulative incidence rate of mood disorder of 36.90%, 41.56%, and 33.89%, respectively. The multiple cox proportional model further revealed that early (hazard ratio [HR] = 1.06, 95% confidence interval (CI) = 0.93-1.21) and delayed (HR = 1.17, 95% CI = 0.96-1.42) reconstruction were associated with a slightly higher but insignificant risk of mood disorder, as compared to the patients received no reconstruction.
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Affiliation(s)
- Hsueh-Hsing Pan
- From the School of Nursing, National Defense Medical Center, Taipei, Taiwan (H-HP, L-FW); Department and Institute of Public Health, College of Medicine, National Cheng-Kung University, Tainan, Taiwan (C-HC, K-CC, C-YL); Department of Nursing, Tri-Service General Hospital, Taipei, Taiwan (L-FW); Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan (P-CH); Jianan Psychiatric Center, Ministry of Health and Welfare, Tainan, Taiwan (K-CC); and Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan (C-YL)
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Emiroğlu M, Karaali C, Sert İ, Salimoğlu S, Uğurlu L, Aksoy S, Aydın C. Comparison of Clinical and Pathological Differences of Breast Cancer Patients under 35 and above 55 Years of Age. THE JOURNAL OF BREAST HEALTH 2015; 11:123-127. [PMID: 28331706 DOI: 10.5152/tjbh.2015.2539] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 12/16/2014] [Indexed: 01/17/2023]
Abstract
OBJECTIVE In this study, we aimed to evaluate the clinical, pathologic and management differences between breast cancer patients under 35 years of age and postmenopausal patients above 55 years of age. MATERIALS AND METHODS Patients who were operated on for breast cancer between November 2003 and March 2013 in our hospital were retrospectively analyzed. Patients were separated into two Groups according their age; Group 1 (<35 years) and Group 2 (>55 years). RESULTS 94 patients with breast cancer, 45 patients in Group 1 and 49 patients in Group 2, were included in the study. The mean follow-up was 51 (19-121) months and 50 (19-120) months in Groups 1 and 2, respectively. Stages of breast cancer at the time of diagnosis were similar between the two groups. The groups were similar in terms of rates of re-excision (p=0.42), local recurrence (p=0.34) and solid organ metastases (p=0.182). The number of oncoplastic and reconstructive procedures were higher in Group 1 (p=0.04). Regarding pathological results, the rate of grade 3 tumors, those with Ki-67>12 and triple negative breast cancer were found to be higher in Group 1. In addition, the number of patients receiving chemotherapy was significantly higher in Group 1 (p=0.03). CONCLUSION Oncologic results were similar between young patients and postmenopausal patients. Nevertheless, tumor biology was found to be worse in young patients. In addition, oncoplastic and reconstructive approaches were significantly higher in young patients.
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Affiliation(s)
- Mustafa Emiroğlu
- Clinic of General Surgery, Tepecik Training and Research Medicine, İzmir, Turkey
| | - Cem Karaali
- Clinic of General Surgery, Tepecik Training and Research Medicine, İzmir, Turkey
| | - İsmail Sert
- Clinic of General Surgery, Tepecik Training and Research Medicine, İzmir, Turkey
| | - Semra Salimoğlu
- Clinic of General Surgery, Tepecik Training and Research Medicine, İzmir, Turkey
| | - Levent Uğurlu
- Clinic of General Surgery, Tepecik Training and Research Medicine, İzmir, Turkey
| | - Süleyman Aksoy
- Clinic of General Surgery, Tepecik Training and Research Medicine, İzmir, Turkey
| | - Cengiz Aydın
- Clinic of General Surgery, Tepecik Training and Research Medicine, İzmir, Turkey
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