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Yamaguchi T, Kadoya S, Hayashi K, Gunjigake K, Sakimura Y, Ohbatake Y, Terai S, Kitamura H, Bando H, Inaki N. Non-inferiority of additional gastrectomy after endoscopic submucosal dissection compared with surgery alone on long-term prognosis: A propensity score-matching analysis. J Gastrointest Surg 2024:S1091-255X(24)00529-8. [PMID: 38964536 DOI: 10.1016/j.gassur.2024.06.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 06/10/2024] [Accepted: 06/30/2024] [Indexed: 07/06/2024]
Abstract
BACKGROUND Patients in whom endoscopic submucosal dissection (ESD) has resulted in non-curative resection need further surgical treatment. However, the oncological outcome of additional gastrectomy after ESD compared with surgery alone remains unclear. METHODS The clinical data of 778 patients who underwent gastrectomy for early gastric cancer from January 2008 to December 2019 in Ishikawa Prefectural Central Hospital were retrospectively analyzed. Of these 778 patients, 187 underwent additional gastrectomy after ESD (ESD (+) group) and 591 underwent surgery alone (ESD (-) group). We compared the overall survival and disease-free survival between the ESD (+) and ESD (-) groups, using propensity score matching to adjust for baseline characteristics. We also assessed early postoperative outcomes. RESULTS After propensity score matching based on sex, age, tumor diameter, tumor gross type, and operative procedure, each group comprised 144 patients with no significant differences in clinical background characteristics. After matching, the 5-year overall survival rate in the ESD (+) and ESD (-) group was 90.9% and 87.8%, respectively, with no significant difference (P = 0.470). In addition, there was no significant difference in the disease-free survival rate (97.6% vs. 95.8%, respectively; P = 0.504). The postoperative complication rate was similar in both groups. CONCLUSION Additional gastrectomy for patients in whom ESD resulted in non-curative resection did not adversely affect the long-term prognosis. Additional gastrectomy after ESD is oncologically acceptable for early gastric cancer.
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Affiliation(s)
- Takahisa Yamaguchi
- Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, Ishikawa 920-8530, Japan.
| | - Shinichi Kadoya
- Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, Ishikawa 920-8530, Japan
| | - Kengo Hayashi
- Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, Ishikawa 920-8530, Japan
| | - Katsuya Gunjigake
- Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, Ishikawa 920-8530, Japan
| | - Yusuke Sakimura
- Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, Ishikawa 920-8530, Japan
| | - Yoshinao Ohbatake
- Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, Ishikawa 920-8530, Japan
| | - Shiro Terai
- Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, Ishikawa 920-8530, Japan
| | - Hirotaka Kitamura
- Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, Ishikawa 920-8530, Japan
| | - Hiroyuki Bando
- Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, Ishikawa 920-8530, Japan
| | - Noriyuki Inaki
- Department of Gastrointestinal Surgery, Kanazawa University, Ishikawa 920-8641, Japan
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Wang HQ, Lin H, Liu B. Research progress on the psychological burden and intervention measures in cancer patients. Front Psychiatry 2024; 15:1408762. [PMID: 38938456 PMCID: PMC11208330 DOI: 10.3389/fpsyt.2024.1408762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 05/16/2024] [Indexed: 06/29/2024] Open
Abstract
In the past 40 years, the gradually increasing incidence and mortality rates of malignant tumors have severely impacted the quality of life of patients, bringing significant physical and psychological burdens and becoming an increasingly serious social issue. With the development of medical standards, new methods for cancer detection and treatment have been continuously proposed. Although it has been proven that cancer is related to increased psychological burden and suicidal behaviors in patients, current research on the psychological burden caused by cancer is insufficient. Clinicians often overlook the psychological health issues of patients while treating their physical diseases. Considering the high incidence of cancer, this review will outline the psychological burdens of cancer patients worldwide in recent years and its high-risk factors. Moreover, this review will summarize the common methods for evaluating psychological burdens, present current predictive models and treatment methods for the psychological burden of cancer patients, aiming to provide a research basis and future direction for the timely and accurate assessment of the psychological burden in cancer patients.
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Affiliation(s)
- Han-Qi Wang
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Hao Lin
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Bing Liu
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, China
- Department of Oral & Maxillofacial Head Neck Oncology, School & Hospital of Stomatology, Wuhan University, Wuhan, China
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Wei X, Yu S, Wang J, Xiang Z, Liu L, Min Y. Association between time from diagnosis to treatment and survival of patients with nasopharyngeal carcinoma: A population-based cohort study. Curr Probl Cancer 2024; 48:101060. [PMID: 38211418 DOI: 10.1016/j.currproblcancer.2024.101060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 12/06/2023] [Accepted: 01/05/2024] [Indexed: 01/13/2024]
Abstract
BACKGROUND Treatment delays have frequently been observed in cancer patients. Whether the treatment delays would impair the survival of patients with nasopharyngeal carcinoma (NPC) is still unclear. METHODS The data were derived from the Surveillance, Epidemiology, and End Results (SEER) database between 2010 and 2015. Patients were divided into groups of timely treatment (<1 month), intermediate delay (1 and 2 months), and long delay (3-6 months). The influence of different treatment delay intervals on long-term survival was evaluated by multivariate Cox regression analysis. RESULTS In total, 2,048 patients with NPC were included in our study. There were 551 patients in the early stage (I, II stage: 26.9 %) and 1,497 patients in the advanced stage (III, IV stage: 73.1 %). No significant difference in overall survival (OS) or cancer-specific survival (CSS) was observed among the groups with various treatment delay intervals (p = 0.48 in OS and p = 0.43 in CSS, respectively). However, upon adjusting for covariates, a significantly improved OS probability emerged in patients with intermediate treatment delays compared to those who received timely interventions in both the entire study population (adjustedHazard Ratio (aHR)=0.86, 95 % CI: 0.74-0.99, p = 0.043) and the subgroup with advanced stage (aHR=0.85, 95 % CI: 0.72-1.00, p = 0.049). Regarding the CSS probability, similar associations were also observed in the entire study population (aHR=0.84, 95 % CI: 0.71-0.98, p = 0.030) as well as the advanced-stage patients (aHR=0.83, 95 % CI: 0.70-0.99, p = 0.038). CONCLUSIONS Our results revealed that treatment delays are not associated with worse survival of NPC patients. Tumor-specific characteristics and subsequent treatment modalities play more pivotal roles in the prognosis of NPC.
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Affiliation(s)
- Xiaoyuan Wei
- Department of Head and Neck Oncology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, PR China
| | - Siting Yu
- Department of Head and Neck Oncology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, PR China
| | - Jun Wang
- Department of Head and Neck Oncology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, PR China
| | - Zhongzheng Xiang
- Department of Head and Neck Oncology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, PR China
| | - Lei Liu
- Department of Head and Neck Oncology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, PR China.
| | - Yu Min
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, PR China
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Yen C, Yang Y, Ku H, Hu H, Lo S, Chang H, Chao Y, Chen J, Wang H, Wang T, Bai L, Wu M, Yen C, Chen L, Shan Y. The impact of preoperative waiting time in Stage II-III gastric or gastroesophageal junction cancer: A population-based cohort study. Cancer Med 2023; 12:16906-16917. [PMID: 37401402 PMCID: PMC10501262 DOI: 10.1002/cam4.6320] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 06/06/2023] [Accepted: 06/25/2023] [Indexed: 07/05/2023] Open
Abstract
BACKGROUND Gastrectomy remains the curative option in gastric cancer. However, the growing concern that preoperative waiting jeopardizes survival has not been fully addressed. The present population-based cohort study aimed to clarify the impact of preoperative waiting time (PreWT). METHODS We included patients with clinical Stage II-III gastric cancer who received curative surgery from 2008 to 2017 of Taiwan Cancer Registry. PreWT was defined as the time from endoscopic diagnosis to surgery. The prognostic impact on overall survival (OS) was evaluated with Cox and restricted cubic spline regressions. RESULTS A total of 3059 patients with a median age of 68 years were evaluated. The median PreWT was 16 days (interquartile range, 11-24 days), and patients with a shorter PreWT were younger, had a more advanced disease and received adjuvant therapies. Despite a shorter OS occurring with prolonged PreWT (median OS by PreWT [days]: 7-13, 2.7 years; 14-20, 3.1 years; 21-27, 3.0 years; 28-34, 4.7 years; 35-31, 3.7 years; 42-48, 3.4 years; 49-118, 2.8 years; p = 0.029), the differences were not significant after adjustment. The Cox and restricted cubic spline regressions showed that prolonged PreWT was not a significant prognostic factor for OS (p = 0.719). CONCLUSIONS The population-based study suggests that a PreWT of 49-118 days does not independently correlate with a poor prognosis in Stage II-III gastric cancer. The study provides rationale for a window period for preoperative therapies and patient optimization.
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Affiliation(s)
- Chih‐Chieh Yen
- Department of OncologyNational Cheng Kung University Hospital, College of Medicine, National Cheng Kung UniversityTainanTaiwan
- Institute of Clinical Medicine, School of MedicineNational Cheng Kung UniversityTainanTaiwan
| | - Yi‐Hsin Yang
- National Institute of Cancer Research, National Health Research InstitutesTainanTaiwan
| | - Hsiu‐Ying Ku
- National Institute of Cancer Research, National Health Research InstitutesTainanTaiwan
- Department of Healthcare AdministrationAsia UniversityTaichungTaiwan
| | - Huang‐Ming Hu
- Department of Internal MedicineKaohsiung Medical University Hospital, Kaohsiung Medical UniversityKaohsiungTaiwan
- Department of Internal MedicineKaohsiung Municipal Ta‐Tung HospitalKaohsiungTaiwan
| | - Su‐Shun Lo
- Department of SurgeryNational Yang Ming Chiao Tung University HospitalYilanTaiwan
| | - Hung‐Chi Chang
- Department of SurgeryChang‐Hua Christian HospitalChanghuaTaiwan
| | - Yee Chao
- Department of Oncology, School of Medicine, Taipei Veterans General HospitalNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
| | - Jen‐Shi Chen
- Department of Hematology‐OncologyLinkou Chang Gung Memorial Hospital and Chang Gung UniversityLinkouTaiwan
| | - Hsiu‐Po Wang
- Department of Internal MedicineNational Taiwan University College of Medicine and HospitalTaipeiTaiwan
| | - Tsang‐En Wang
- Department of Internal MedicineMackay Memorial HospitalTaipeiTaiwan
| | - Li‐Yuan Bai
- Division of Hematology and Oncology, Department of Internal MedicineChina Medical University Hospital, and China Medical UniversityTaichungTaiwan
| | - Ming‐Shiang Wu
- Department of Internal MedicineNational Taiwan University College of Medicine and HospitalTaipeiTaiwan
| | - Chia‐Jui Yen
- Department of OncologyNational Cheng Kung University Hospital, College of Medicine, National Cheng Kung UniversityTainanTaiwan
| | - Li‐Tzong Chen
- National Institute of Cancer Research, National Health Research InstitutesTainanTaiwan
- Department of Internal MedicineKaohsiung Medical University Hospital, Kaohsiung Medical UniversityKaohsiungTaiwan
| | - Yan‐Shen Shan
- Institute of Clinical Medicine, School of MedicineNational Cheng Kung UniversityTainanTaiwan
- Department of Surgery, National Cheng Kung University HospitalCollege of Medicine, National Cheng Kung UniversityTainanTaiwan
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Lee YJ, Jeong JH, Jung J, Yoo TK, Lee SB, Kim J, Ko BS, Kim HJ, Lee JW, Son BH, Chung IY. Waiting Time for Breast Cancer Treatment in Korea: A Nationwide Cohort Study. J Breast Cancer 2023; 26:334-343. [PMID: 37565927 PMCID: PMC10475710 DOI: 10.4048/jbc.2023.26.e26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 03/14/2023] [Accepted: 05/14/2023] [Indexed: 08/12/2023] Open
Abstract
PURPOSE This study aimed to analyze the waiting time for initial treatment after breast cancer diagnosis and determine the factors influencing treatment delay in South Korea. METHODS This nationwide retrospective cohort study was conducted using the Health Insurance Review and Assessment data. The participants were classified according to the regions where their biopsy and treatment were performed (Seoul-Seoul, Metro-Metro, Other-Other, Metro-Seoul, Other-Seoul). Waiting time was analyzed according to regional subgroup, year of diagnosis, and type of treatment. Multivariable logistic regression models were constructed to identify the factors associated with treatment delay (after 30 days of diagnosis). RESULTS A total of 133,514 participants newly diagnosed between January 2010 and December 2017 were included in the study. The median waiting time for initial treatment in the total population increased from 8 days, in 2010, to 14 days, in 2017. In the Seoul-Seoul group, the waiting time increased from 10 days, in 2010, to 16 days, in 2017. Although the median waiting time was approximately 10 days in the Metro-Metro and Other-Other groups, it was 27 and 24 days, in the Metro-Seoul and Other-Seoul group, respectively, in 2017. The proportion of delayed upfront surgery by more than 30 days was higher in the Metro-Seoul (odds ratio [OR], 8.088; 95% confidence interval [CI], 7.357-8.893; p < 0.001) and Other-Seoul (OR, 6.210; 95% CI, 5.717-6.750; p < 0.001) groups than in the Metro-Metro (OR, 1.468; 95% CI, 1.352-1.594; p < 0.001) and Other-Other (reference) groups. Previous medical history and treatment at tertiary hospital were observed as factors related to delayed surgery. CONCLUSION Waiting times for breast cancer surgery have increased across all regions of Korea, with those traveling to Seoul experiencing particularly long wait times.
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Affiliation(s)
- Young-Jin Lee
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Ho Jeong
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jinhong Jung
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae-Kyung Yoo
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sae Byul Lee
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jisun Kim
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Beom Seok Ko
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hee Jeong Kim
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jong Won Lee
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Byung Ho Son
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Il Yong Chung
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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Jeong JH, Jung J, Kim HJ, Lee JW, Ko BS, Son BH, Jung KH, Chung IY. Domestic medical travel from non-Seoul regions to Seoul for initial breast cancer treatment: a nationwide cohort study. Ann Surg Treat Res 2023; 104:71-79. [PMID: 36816739 PMCID: PMC9929435 DOI: 10.4174/astr.2023.104.2.71] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 11/09/2022] [Accepted: 11/10/2022] [Indexed: 02/09/2023] Open
Abstract
Purpose This study was conducted to investigate the trend of domestic medical travel from non-Seoul areas to Seoul for initial breast cancer treatment, and identify factors associated with medical travel in breast cancer patients. Methods A nationwide retrospective cohort study was performed using the Health Insurance Review and Assessment data of South Korea. Patients were classified according to the regions in which they underwent breast biopsy (Seoul vs. metropolitan cities vs. other regions). Frequencies of biopsy, diagnosis, treatment, and domestic medical travel were analyzed according to regions, and factors associated with medical travel were investigated. Results A total of 150,709 breast cancer survivors who were diagnosed between January 2010 and December 2017 were included. The total rate of medical travel from non-Seoul regions to Seoul had increased from 14.2% (1,161 of 8,150) in 2010 to 19.8% (2,762 of 13,964) in 2017. Approximately a quarter of patients from other regions traveled to Seoul, and over 40% of patients from Chungbuk, Gyeongbuk, and Jeju regions traveled to Seoul for initial treatment in 2017. The difference in the annual frequencies of upfront surgery between Seoul and non-Seoul regions increased over time. Younger age and regions other than metropolitan cities were significantly related to medical travel. Patients covered by medical aid or past medical histories were significantly less likely to travel to Seoul for initial breast cancer treatment. Conclusion Medical travel to Seoul for upfront breast cancer surgery is increasing. Policies for appropriate healthcare delivery need to be established in the near future.
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Affiliation(s)
- Jae Ho Jeong
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jinhong Jung
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hee Jeong Kim
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jong Won Lee
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Beom-Seok Ko
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Byung Ho Son
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyung Hae Jung
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Il Yong Chung
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Roy M, Finch L, Kwon D, Jordan SE, Yadegarynia S, Wolfson AH, Slomovitz B, Portelance L, Huang M. Factors contributing to delays in initiation of front-line cervical cancer therapy: disparities in a diverse south Florida population. Int J Gynecol Cancer 2022; 32:1387-1394. [PMID: 36198435 PMCID: PMC9664089 DOI: 10.1136/ijgc-2022-003475] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Objective Delay in initiating cervical cancer treatment may impact outcomes. In a cohort of patients initially treated by surgery, chemoradiation, chemotherapy, or in a clinical trial, we aim to define factors contributing to prolonged time to treatment initiation. Methods Data from patients initiating treatment for cervical cancer at a single institution was abstracted. Time to treatment initiation was defined as the interval from the date of cancer diagnosis to the date of treatment initiation. Poisson regression model was used for analysis. Results Of 274 patients studied, the median time to treatment initiation was 60 days (range 0–551). The median times to initiate surgery (54 days, range 3–96) and chemoradiation (58 days, range 4–187) were not significantly different (relative risk (RR) 1.01, 95% CI 0.98 to 1.04, p=0.54). The shortest median initiation time was for chemotherapy (47 days; RR 1.13, 95% CI 1.08 to 1.19, p<0.0001) and the longest was for clinical trial (62 days; RR 1.18, 95% CI 1.12 to 1.24, p<0.0001). Charity care (RR 1.09, 95% CI 1.05 to 1.14, p<0.0001), Medicare or Medicaid (RR 1.10, 95% CI 1.06 to 1.14, p<0.0001), and self-pay (RR 1.38, 95% CI 1.32 to 1.45, p<0.0001) delayed treatment initiation more than private insurance. Hispanic White women (RR 0.69, 95% CI 0.66 to 0.73, p<0.0001) had a shorter treatment initiation time compared with non-Hispanic White patients, while Afro-Caribbean/Afro-Latina women (RR 0.86, 95% CI 0.81 to 0.90, p<0.0001) and African-American patients (RR 1.13, 95% CI 1.07 to 1.19, p<0.0001) had longer initiation times. Spanish speaking patients did not have a prolonged treatment initiation (RR 0.68, 95% CI 0.66 to 0.71, p<0.0001), though Haitian-Creole speaking patients did (RR 1.07, 95% CI 1.01 to 1.13, p<0.002). Diagnosis at an outside institution delayed treatment initiation time (RR 1.24, 95% CI 1.18 to 1.30, p<0.0001) compared with diagnosis at the cancer center. Conclusion Factors associated with prolonged time to treatment initiation include treatment modality, insurance status, language spoken, and institution of diagnosis. By closely examining each of these factors, barriers to treatment can be identified and modified to shorten treatment initiation time.
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Affiliation(s)
- Molly Roy
- Gynecologic Oncology, University of Miami Miller School of Medicine/Jackon Memorial Hospital, Miami, Florida, USA
| | - Lindsey Finch
- Obstetrics and Gynecology, Jackson Memorial Hospital, Miami, Florida, USA
| | - Deukwoo Kwon
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Scott E Jordan
- Gynecologic Oncology, University of Miami Miller School of Medicine/Jackon Memorial Hospital, Miami, Florida, USA
| | - Sina Yadegarynia
- University of Miami Miller School of Medicine, Miami, Florida, USA
| | | | - Brian Slomovitz
- Gynecologic Oncology, Mount Sinai Medical Center, Miami Beach, Florida, USA
| | | | - Marilyn Huang
- Gynecologic Oncology, Mount Sinai Medical Center, Miami Beach, Florida, USA
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Chen AJ, Zhang J, Agarwal A, Lakdawalla DN. Value of Reducing Wait Times for Chimeric Antigen Receptor T-Cell Treatment: Evidence From Randomized Controlled Trial Data on Tisagenlecleucel for Diffuse Large B-Cell Lymphoma. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:1344-1351. [PMID: 35341689 DOI: 10.1016/j.jval.2022.02.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 01/30/2022] [Accepted: 02/08/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES This study aimed to quantify the value of reducing chimeric antigen receptor T-cell (CAR-T) treatment wait times on patients with refractory and relapsed aggressive blood cancer who can newly gain access to treatment or access treatment earlier in their disease course. METHODS Using data from the JULIET clinical trial, we first identified the number of additional patients with diffuse large B-cell lymphoma that would have been treated with tisagenlecleucel CAR-T therapy if wait times were shortened. For these patients, we estimated mortality benefits using literature estimates of CAR-T effectiveness. Next, among patients who already received CAR-T, we estimated tumor burden progression over time using a linear probability regression model. The primary outcome variable was an indicator for having above-normal lactate dehydrogenase, and we controlled for time, use of bridging therapy, and time-invariant patient characteristics. The regression results, along with literature estimates relating lactate dehydrogenase to CAR-T effectiveness, were used to compute the survival benefits of earlier CAR-T treatment. RESULTS Reducing wait times by 2 months increased the number of eligible patients receiving CAR-T by at least 10.7%. For patients already receiving tisagenlecleucel CAR-T, a 2-month reduction in wait times generated a 3.3% increase in survival gains per treated patient. Thus, among patients seeking treatment, the combined treatment efficacy increased by 14%, with approximately one-quarter of survival benefits accruing to existing patients receiving faster treatment. CONCLUSIONS Delays affected not only access to CAR-T treatments but also treatment effectiveness. Our results highlight the survival benefits of expediting treatment access and may help explain some observed differences in CAR-T effectiveness across countries.
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Affiliation(s)
- Alice J Chen
- Sol Price School of Public Policy and Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, USA.
| | - Jie Zhang
- Novartis Pharmaceuticals, Basel, Switzerland
| | | | - Darius N Lakdawalla
- Sol Price School of Public Policy and Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, USA
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Xu L, Sanders L, Li K, Chow JCL. Chatbot for Health Care and Oncology Applications Using Artificial Intelligence and Machine Learning: Systematic Review. JMIR Cancer 2021; 7:e27850. [PMID: 34847056 PMCID: PMC8669585 DOI: 10.2196/27850] [Citation(s) in RCA: 79] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 07/02/2021] [Accepted: 09/18/2021] [Indexed: 01/01/2023] Open
Abstract
Background Chatbot is a timely topic applied in various fields, including medicine and health care, for human-like knowledge transfer and communication. Machine learning, a subset of artificial intelligence, has been proven particularly applicable in health care, with the ability for complex dialog management and conversational flexibility. Objective This review article aims to report on the recent advances and current trends in chatbot technology in medicine. A brief historical overview, along with the developmental progress and design characteristics, is first introduced. The focus will be on cancer therapy, with in-depth discussions and examples of diagnosis, treatment, monitoring, patient support, workflow efficiency, and health promotion. In addition, this paper will explore the limitations and areas of concern, highlighting ethical, moral, security, technical, and regulatory standards and evaluation issues to explain the hesitancy in implementation. Methods A search of the literature published in the past 20 years was conducted using the IEEE Xplore, PubMed, Web of Science, Scopus, and OVID databases. The screening of chatbots was guided by the open-access Botlist directory for health care components and further divided according to the following criteria: diagnosis, treatment, monitoring, support, workflow, and health promotion. Results Even after addressing these issues and establishing the safety or efficacy of chatbots, human elements in health care will not be replaceable. Therefore, chatbots have the potential to be integrated into clinical practice by working alongside health practitioners to reduce costs, refine workflow efficiencies, and improve patient outcomes. Other applications in pandemic support, global health, and education are yet to be fully explored. Conclusions Further research and interdisciplinary collaboration could advance this technology to dramatically improve the quality of care for patients, rebalance the workload for clinicians, and revolutionize the practice of medicine.
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Affiliation(s)
- Lu Xu
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada.,Department of Medical Biophysics, Western University, London, ON, Canada
| | - Leslie Sanders
- Department of Humanities, York University, Toronto, ON, Canada
| | - Kay Li
- Department of English, York University, Toronto, ON, Canada
| | - James C L Chow
- Department of Medical Physics, Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
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Rehabilitation Nursing Intervention Can Improve Dysphagia and Quality of Life of Patients Undergoing Radiotherapy for Esophageal Cancer. JOURNAL OF ONCOLOGY 2021; 2021:3711699. [PMID: 34394350 PMCID: PMC8360714 DOI: 10.1155/2021/3711699] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 07/29/2021] [Indexed: 12/27/2022]
Abstract
Objective To seek the improvement of rehabilitation nursing intervention on dysphagia and quality of life of patients with esophageal cancer undergoing radiotherapy. Methods A total of 109 patients with esophageal cancer undergoing radiotherapy were selected as research objects. According to the random number table, they were separated into the control group (CG) and intervention group (IG), with 45 cases in CG and 64 cases in IG. In CG, patients were given routine nursing intervention, while those in IG were given rehabilitation nursing intervention. After intervention, the degree of acute radiation injury and the improvement of swallowing function were observed to compare the self-nursing ability, quality of life, and incidence of complications between the two groups. Results The degree of injury in CG was heavier than that in IG. The improvement of swallowing function in IG was better than that in CG. The scores of self-nursing ability and life quality in IG were higher than those in CG, with statistically significant differences (p < 0.05). The incidence of complications in IG was obviously lower than that in CG (p < 0.05). Conclusion Rehabilitation nursing intervention can ameliorate dysphagia, improve the quality of life, and reduce the incidence of complications for patients with esophageal cancer undergoing radiotherapy. It is worthy of clinical application.
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11
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Nassali MN, Melese T, Modimowame J, Moreri-Ntshabele B. Timelines to Cervical Cancer Diagnosis and Treatment at a Tertiary Hospital in Botswana. Int J Womens Health 2021; 13:385-393. [PMID: 33935521 PMCID: PMC8079250 DOI: 10.2147/ijwh.s298204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 03/28/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To describe the timelines leading to presentation, diagnosis and definitive treatment among cervical cancer patients at a tertiary treatment center in Botswana. Patients and Methods This was a retrospective study that evaluated timelines to diagnosis and linkage to definitive treatment among cervical cancer patients in Botswana. Medical records of 149 patients admitted at Princess Marina Hospital (PMH) from 2012 to 2014 were reviewed from August 2016 to February 2017. Data collected included socio-demographics, stage of disease at presentation, symptom duration at presentation, diagnosis to definitive treatment interval and treatment outcomes on discharge. STATA 12 was used for data analysis. Frequencies and percentages were used to analyse and present the data. This paper is limited to the analysis of records with documented duration of symptoms, histology turnaround time and the diagnosis to treatment interval. Results The median duration of symptoms at presentation (N= 80) was 120 days (range 1–1290). Women who were HIV seropositive, of secondary level education or higher, below 50 years and those with cervical cancer screening history reported shorter duration of symptoms at presentation. Median histopathology turnaround time (N=123) was 27 days (range 3–274), median diagnosis to definitive chemoradiation interval (N=81) was 89 days (range 16–305) while median waiting time for surgery (N=7) was 60 days (range 29–279). Overall, the patients’ journey from the community to definitive treatment was about six months. Conclusion Delayed cervical cancer diagnosis and treatment is multifactorial and entails a complex interplay between patient health-seeking behavioural patterns, robustness of the patient referral and follow-up mechanisms, availability of prompt histopathology services and relay of results, and timely linkage to definitive care. Prioritization of strategies to address hurdles in all these aspects will not only reduce waiting times but also ensure timely management and improved outcomes among patients with cervical cancer.
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Affiliation(s)
- Mercy-Nkuba Nassali
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Botswana, Gaborone, Botswana.,Department of Obstetrics and Gynaecology, Princess Marina Hospital, Gaborone, Botswana
| | - Tadele Melese
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Botswana, Gaborone, Botswana.,Department of Obstetrics and Gynaecology, Princess Marina Hospital, Gaborone, Botswana
| | - Jamieson Modimowame
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Botswana, Gaborone, Botswana.,Department of Obstetrics and Gynaecology, Princess Marina Hospital, Gaborone, Botswana
| | - Badani Moreri-Ntshabele
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Botswana, Gaborone, Botswana.,Department of Obstetrics and Gynaecology, Princess Marina Hospital, Gaborone, Botswana
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12
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Qi N, Zhao F, Liu X, Wei W, Wang J. Safety of Prolonged Wait Time for Nephrectomy for Clinically Localized Renal Cell Carcinoma. Front Oncol 2021; 11:617383. [PMID: 33859936 PMCID: PMC8042291 DOI: 10.3389/fonc.2021.617383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 03/16/2021] [Indexed: 12/28/2022] Open
Abstract
Background There is usually a surgical wait time before nephrectomy for patients with clinically localized renal cell carcinoma, and many factors can influence this preoperative wait time. A relatively prolonged wait time may cause tumor progression. Therefore, we assessed the effect of preoperative wait time on the prognosis of patients with clinically localized renal cell carcinoma. Methods The outcomes of 561 patients with clinically localized renal cell carcinoma who underwent nephrectomy between July 2011 and March 2017 were retrospectively evaluated. According to the wait time before surgery, we divided the patients into three groups: short-wait group (≤ 30 days), intermediate-wait group (> 30 and ≤ 90 days), and long-wait group (>90 days). The clinicopathological characteristics were evaluated, and the survival rates of the three groups were compared. Results This study included 370 male (66%) and 191(34%) female patients, with a median age of 64 years. There were 520 patients with stage T1 and 41 patients with stage T2 tumors. The median interval between diagnosis and surgery was 21 days. There were no significant differences in age, sex, Eastern Cooperative Oncology Group (ECOG) performance status, body mass index, tumor size, surgical approach, surgical procedure, pathological subtype, tumor stage, tumor grade, and residual tumor among the three groups. Overall survival(OS) and cancer-specific survival (CSS) were comparable; the 5-year OS of the short-, intermediate-, and long-wait time groups were 84.2%, 82.0%, and 89.8%, respectively (P=0.732). The 5-year CSS rates of the short-, intermediate-, and long-wait time groups were 87.1%, 88.9%, and 90.4%, respectively (P=0.896). Multivariate analysis revealed that wait time was not an independent prognostic factor for OS or CSS. Conclusion Prolonged surgical wait time (> 90 days) does not influence survival in patients with clinically localized renal cell carcinoma.
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Affiliation(s)
- Nienie Qi
- Department of Urology, The Affiliated Hospital of Xuzhou Medical University. Xuzhou Medical University, Xuzhou, China
| | - Fangzheng Zhao
- Department of Urology, The Affiliated Hospital of Xuzhou Medical University. Xuzhou Medical University, Xuzhou, China
| | - Xiaoxiao Liu
- Department of Radiation Oncology, Cancer Center, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.,Jiangsu Center for the Collaboration and Innovation of Cancer Biotherapy, Cancer Institute, Xuzhou Medical University, Xuzhou, China
| | - Wei Wei
- Department of Health Management Center, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Junqi Wang
- Department of Urology, The Affiliated Hospital of Xuzhou Medical University. Xuzhou Medical University, Xuzhou, China
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13
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Rupp SK, Stengel A. Influencing Factors and Effects of Treatment on Quality of Life in Patients With Gastric Cancer-A Systematic Review. Front Psychiatry 2021; 12:656929. [PMID: 34276435 PMCID: PMC8280526 DOI: 10.3389/fpsyt.2021.656929] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 05/31/2021] [Indexed: 12/12/2022] Open
Abstract
Background: Gastric cancer (GC) is one of the leading causes of death worldwide. It is associated with several disease-related impairments contributing to the psycho-social burden of those patients, such as deterioration of well-being and overall quality of life (QOL). The aim of this study is to present the wide range of factors potentially impacting patients' overall well-being and possible preventive interventions. Methods: This systematic review was conducted in October 2020 with a search in the PubMed, MedLine, PsycInfo, and Google Scholar databases. We used the keywords "gastric cancer," "gastric neoplasm," and each of them combined with "quality of life," "depression," and "anxiety" to identify all relevant articles reporting about potential impact factors influencing the overall well-being of patients suffering from gastric cancer. Results: Finally, 125,490 articles were found, of which 125,431 were excluded in several steps of screening. Inclusion criteria were studies carried out on human ≥18 years of age, studies in English or German language, clinical trials, registry-based studies, cohort studies, population-based studies, and certain titles and abstracts. After screening for eligibility 35 potential factors influencing overall well-being in patients with GC were identified and classified into 9 important categories: genetic condition, treatment method, blood markers, nutritional status, daily living, state of health, mental state, supportive care, and alternative treatment. Conclusion: Since various factors are involved in the development of patients' overall well-being, timely treatment of psycho-social impairments by physicians and psychologists is of enormous importance. Preventing psycho-social burden by improving patients' QOL should be of high importance in the treatment regimen of patients with GC.
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Affiliation(s)
- Sophia Kristina Rupp
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Andreas Stengel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.,Section Psychooncology, Comprehensive Cancer Center Tübingen Stuttgart, University Hospital Tübingen, Tübingen, Germany.,Department for Psychosomatic Medicine, Charité Center for Internal Medicine and Dermatology, Charite-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
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14
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Warps AK, de Neree tot Babberich MPM, Dekker E, Wouters MWJM, Dekker JWT, Tollenaar RAEM, Tanis PJ. Interhospital referral of colorectal cancer patients: a Dutch population-based study. Int J Colorectal Dis 2021; 36:1443-1453. [PMID: 33743051 PMCID: PMC8195929 DOI: 10.1007/s00384-021-03881-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/04/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE Interhospital referral is a consequence of centralization of complex oncological care but might negatively impact waiting time, a quality indicator in the Netherlands. This study aims to evaluate characteristics and waiting times of patients with primary colorectal cancer who are referred between hospitals. METHODS Data were extracted from the Dutch ColoRectal Audit (2015-2019). Waiting time between first tumor-positive biopsy until first treatment was compared between subgroups stratified for referral status, disease stage, and type of hospital. RESULTS In total, 46,561 patients were included. Patients treated for colon or rectal cancer in secondary care hospitals were referred in 12.2% and 14.7%, respectively. In tertiary care hospitals, corresponding referral rates were 43.8% and 66.4%. Referred patients in tertiary care hospitals were younger, but had a more advanced disease stage, and underwent more often multivisceral resection and simultaneous metastasectomy than non-referred patients in secondary care hospitals (p<0.001). Referred patients were more often treated within national quality standards for waiting time compared to non-referred patients (p<0.001). For referred patients, longer waiting times prior to MDT were observed compared to non-referred patients within each hospital type, although most time was spent post-MDT. CONCLUSION A large proportion of colorectal cancer patients that are treated in tertiary care hospitals are referred from another hospital but mostly treated within standards for waiting time. These patients are younger but often have a more advanced disease. This suggests that these patients are willing to travel more but also reflects successful centralization of complex oncological patients in the Netherlands.
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Affiliation(s)
- A. K. Warps
- grid.10419.3d0000000089452978Department of Surgery and Biomedical Data Sciences, Leiden University Medical Center, Albinusdreef 2, 2333ZA Leiden, Netherlands ,Scientific Bureau, Dutch Institute for Clinical Auditing, Rijnsburgerweg 10, 2333AA Leiden, Netherlands
| | - M. P. M. de Neree tot Babberich
- grid.7177.60000000084992262Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105AZ Amsterdam, Netherlands
| | - E. Dekker
- grid.7177.60000000084992262Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105AZ Amsterdam, Netherlands
| | - M. W. J. M. Wouters
- grid.10419.3d0000000089452978Department of Surgery and Biomedical Data Sciences, Leiden University Medical Center, Albinusdreef 2, 2333ZA Leiden, Netherlands ,Scientific Bureau, Dutch Institute for Clinical Auditing, Rijnsburgerweg 10, 2333AA Leiden, Netherlands ,grid.430814.aDepartment of Surgical Oncology, Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066CX Amsterdam, Netherlands
| | - J. W. T. Dekker
- grid.415868.60000 0004 0624 5690Department of Surgery, Reinier de Graaf Groep, Reinier de Graafweg 5, 2625AD Delft, Netherlands
| | - R. A. E. M. Tollenaar
- grid.10419.3d0000000089452978Department of Surgery and Biomedical Data Sciences, Leiden University Medical Center, Albinusdreef 2, 2333ZA Leiden, Netherlands ,Scientific Bureau, Dutch Institute for Clinical Auditing, Rijnsburgerweg 10, 2333AA Leiden, Netherlands
| | - P. J. Tanis
- grid.7177.60000000084992262Department of Surgery, Cancer Centre Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105AZ Amsterdam, Netherlands
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Nilbert M, Thomsen LA, Winther Jensen J, Møller H, Borre M, Widenlou Nordmark A, Lambe M, Brändström H, Kørner H, Møller B, Ursin G. The power of empirical data; lessons from the clinical registry initiatives in Scandinavian cancer care. Acta Oncol 2020; 59:1343-1356. [PMID: 32981417 DOI: 10.1080/0284186x.2020.1820573] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND In Scandinavia, there is a strong tradition for research and quality monitoring based on registry data. In Denmark, Norway and Sweden, 63 clinical registries collect data on disease characteristics, treatment and outcome of various cancer diagnoses and groups based on process-related and outcome-related variables. AIM We describe the cancer-related clinical registries, compare organizational structures and quality indicators and provide examples of how these registries have been used to monitor clinical performance, develop prediction models, assess outcome and provide quality benchmarks. Further, we define unmet needs such as inclusion of patient-reported outcome variables, harmonization of variables and barriers for data sharing. RESULTS AND CONCLUSIONS The clinical registry framework provides an empirical basis for evidence-based development of high-quality and equitable cancer care. The registries can be used to follow implementation of new treatment principles and monitor patterns of care across geographical areas and patient groups. At the same time, the lessons learnt suggest that further developments and coordination are needed to utilize the full potential of the registry initiative in cancer care.
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Affiliation(s)
- Mef Nilbert
- Department of Oncology, Lund University, Lund, Sweden
- The Danish Cancer Society Research Center, Copenhagen, Denmark
- Clinical Research Department, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark
| | | | - Jens Winther Jensen
- The Danish Clinical Quality Program and Clinical Registries, Aarhus, Denmark
| | - Henrik Møller
- The Danish Clinical Quality Program and Clinical Registries, Aarhus, Denmark
| | - Michael Borre
- The Association of Danish Multidisciplinary Cancer Groups, Aarhus, Denmark
| | | | - Mats Lambe
- The Federation of Regional Cancer Centers, Stockholm, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | | | - Hartwig Kørner
- Institute of Surgical Sciences, University of Bergen, Bergen, Norway
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16
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Husebø AML, Karlsen B, Husebø SE. Health professionals' perceptions of colorectal cancer patients' treatment burden and their supportive work to ameliorate the burden - a qualitative study. BMC Health Serv Res 2020; 20:661. [PMID: 32680491 PMCID: PMC7367378 DOI: 10.1186/s12913-020-05520-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 07/08/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Support is pivotal for patients in managing colorectal cancer treatment, as they might be overwhelmed by the burden of treatment. There is scarce knowledge regarding health professionals' perceptions of colorectal cancer patients' burdens and supportive needs. The study aims to describe health professionals' perspectives on treatment burden among patients receiving curative surgical treatment for colorectal cancer during the hospital stay and how they support patients to ameliorate the burden. METHODS This study has a descriptive and explorative qualitative design, using semi-structured interviews with nine health professionals recruited from a gastrointestinal-surgery ward at a university hospital in Norway. Data were analysed by using systematic text condensation. RESULTS Data analysis identified the themes "capturing patients' burdens of colorectal cancer treatment" and "health professionals' support to ameliorate the burden". Patients with colorectal cancer had to face burdens related to a challenging emotional situation, treatment complications and side effects, and an extensive need for information. A trusting patient-carer relationship was therefore perceived as the essence of health professionals' support. Health professionals focused their support on safeguarding patients, motivating patients to self-manage, and involving family and peers as supporters. Patients' journey characteristics and illness severity challenged health professionals' supportive work. CONCLUSION Support from health professionals includes providing patients emotional support and relevant treatment-related information and motivating patients for early post-surgical mobilisation. Health professionals should be aware of identifying colorectal cancer patients' information needs according to the specific treatment stages, which may ameliorate the burden of colorectal cancer treatment and enable patients to self-manage.
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Affiliation(s)
- Anne Marie Lunde Husebø
- Department of Gastrointestinal Surgery, Stavanger University Hospital, N-4019, Stavanger, Norway.
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, N-4036, Stavanger, Norway.
| | - Bjørg Karlsen
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, N-4036, Stavanger, Norway
| | - Sissel Eikeland Husebø
- Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, N-4036, Stavanger, Norway
- Department of Surgery, Stavanger University Hospital, N-4011, Stavanger, Norway
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17
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Huang VW, Imam SA, Nguyen SA. Head and neck survivorship care in the times of the SARS-CoV-2 pandemic. Head Neck 2020; 42:1664-1667. [PMID: 32358880 PMCID: PMC7267631 DOI: 10.1002/hed.26235] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 04/24/2020] [Indexed: 12/31/2022] Open
Abstract
With the arrival of the coronavirus disease (SARS‐CoV‐2) in the United States, care practice paradigms have drastically changed. Data from China suggest that the new virus poses additional risks as case fatality of patients with cancer was higher at 5.6% compared to 2.3% of the general population. There are three proposed major strategies to address care for patients with cancer in this SARS‐CoV‐2 pandemic with postponing treatment for those with stable cancer, increasing personal protection provisions for patients with cancer, and increasing monitoring if a patient becomes infected with SARS‐CoV‐2. In this present commentary, we discuss the unique mental health challenges and burdens of patients with head and neck cancer in the times of the SARS‐CoV‐2 pandemic and approaches to mitigate these stressors through telemedicine to reduce future burdens to the patient and the health care system.
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Affiliation(s)
- Victoria W Huang
- College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Sarah A Imam
- Department of Health and Human Performance, The Citadel, Charleston, South Carolina, USA
| | - Shaun A Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
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18
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Zhang P, Yao L, Chen M, Feng W. Prognostic factors affecting long-term outcomes in patients with brain metastasis from esophageal carcinoma. Chin J Cancer Res 2020; 32:768-777. [PMID: 33446999 PMCID: PMC7797235 DOI: 10.21147/j.issn.1000-9604.2020.06.10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Objective The incidence of brain metastasis from esophageal cancer (BMEC) has increased in recent years. Thus, it is necessary to identify factors that affect long-term outcomes for such patients. Methods From January 1997 to July 2018, consecutive patients (10,043 patients, 31 with brain metastasis) with esophageal cancer (EC) treated at Zhejiang Cancer Hospital were recruited for retrospective analysis. Demographic, clinical, and pathological variables and the survival data were retrieved. Results The median time from diagnosis of EC to diagnosis of brain metastases was 7.67 (range, 0.43−55.20) months. The median survival time of BMEC patients from diagnosis of primary esophageal tumor was 16.7 (range, 2.33−163.30) months and the median survival time from the point of diagnosis of brain metastasis was 6.47 (range, 0.43−148.13) months. Univariate and multivariate analyses showed that the pathology type, EC without chemotherapy, and bone metastasis history were significantly associated with a shorter time interval between the first treatment of EC and brain metastasis. Chemotherapy history after brain metastasis, whole brain radiation therapy (WBRT) history, and surgery were significant predictors for better long-term survival outcomes. Conclusions Our findings indicate that the use of surgery, WBRT, and chemotherapy can achieve the best therapeutic effects for BMEC patients.
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Affiliation(s)
- Peng Zhang
- Department of Radiology Physics, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou 310022, China
| | - Lejing Yao
- Department of Radiology Physics, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou 310022, China
| | - Ming Chen
- Department of Radiation Oncology, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou 310022, China
| | - Wei Feng
- Department of Radiation Oncology, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou 310022, China
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19
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Jeremiasen M, Linder G, Hedberg J, Lundell L, Björ O, Lindblad M, Johansson J. Improvements in esophageal and gastric cancer care in Sweden-population-based results 2007-2016 from a national quality register. Dis Esophagus 2019; 33:5585604. [PMID: 31608927 PMCID: PMC7672200 DOI: 10.1093/dote/doz070] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 05/23/2019] [Accepted: 06/29/2019] [Indexed: 12/11/2022]
Abstract
The Swedish National Register for Esophageal and Gastric cancer was launched in 2006 and contains data with adequate national coverage and of high internal validity on patients diagnosed with these tumors. The aim of this study was to describe the evolution of esophageal and gastric cancer care as reflected in a population-based clinical registry. The study population was 12,242 patients (6,926 with esophageal and gastroesophageal junction (GEJ) cancers and 5,316 with gastric cancers) diagnosed between 2007 and 2016. Treatment strategies, short- and long-term mortality, gender aspects, and centralization were investigated. Neoadjuvant oncological treatment became increasingly prevalent during the study period. Resection rates for both esophageal/GEJ and gastric cancers decreased from 29.4% to 26.0% (P = 0.022) and from 38.8% to 33.3% (P = 0.002), respectively. A marked reduction in the number of hospitals performing esophageal and gastric cancer surgery was noted. In gastric cancer patients, an improvement in 30-day mortality from 4.2% to 1.6% (P = 0.005) was evident. Overall 5-year survival after esophageal resection was 38.9%, being higher among women compared to men (47.5 vs. 36.6%; P < 0.001), whereas no gender difference was seen in gastric cancer. During the recent decade, the analyses based on the Swedish National Register for Esophageal and Gastric cancer database demonstrated significant improvements in several important quality indicators of care for patients with esophagogastric cancers. The Swedish National Register for Esophageal and Gastric cancer offers an instrument not only for the control and endorsement of quality of care but also a unique tool for population-based clinical research.
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Affiliation(s)
- M Jeremiasen
- Department of Clinical Sciences, Surgery, Lund University, Skane University Hospital, Lund, Sweden,Address correspondence to: Martin Jeremiasen, MD, Department of Surgery, Lund University, Skåne University Hospital, S-221 85 Lund, Sweden.
| | - G Linder
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - J Hedberg
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - L Lundell
- Division of Surgery, Department of Clinical Science, Intervention and Technology Karolinska Institutet (CLINTEC), Centre for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden,Department of Surgery, Odense University Hospital, Odense, Denmark
| | - O Björ
- Department of Radiation Science, Oncology, Umea University, Umea, Sweden
| | - M Lindblad
- Division of Surgery, Department of Clinical Science, Intervention and Technology Karolinska Institutet (CLINTEC), Centre for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - J Johansson
- Department of Clinical Sciences, Surgery, Lund University, Skane University Hospital, Lund, Sweden
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20
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Furukawa K, Irino T, Makuuchi R, Koseki Y, Nakamura K, Waki Y, Fujiya K, Omori H, Tanizawa Y, Bando E, Kawamura T, Terashima M. Impact of preoperative wait time on survival in patients with clinical stage II/III gastric cancer. Gastric Cancer 2019; 22:864-872. [PMID: 30535877 DOI: 10.1007/s10120-018-00910-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 12/01/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Preoperative wait time is affected by various factors, and a certain time is needed before surgery. There is a concern that cancer treatment delay can lead to poor survival. The present study aimed to evaluate the impact of preoperative wait time on survival in patients with clinical stage (cStage) II/III gastric cancer. METHODS The study included patients with cStage II/III primary gastric cancer undergoing surgery between 2002 and 2012. Preoperative wait time was defined as the time from endoscopy for initial diagnosis to surgery. Patients were divided into the following three groups according to wait time: short wait group (≤ 30 days), intermediate wait group (> 30 and ≤ 60 days), and long wait group (> 60 and ≤ 90 days). Patient characteristics and survival were compared among the groups. RESULTS This study included 467 male (67%) and 229 female (33%) patients, and the median patient age was 67 years. The numbers of cStage II and III patients were 332 (48%) and 364 (52%), respectively. The median wait time was 45 days. The body mass index was lower in the short wait group than in the other groups. A shorter wait time tended to be associated with a more advanced cStage. Although survival was significantly worse in the short wait group than in the long wait group, wait time was not identified as an independent prognostic factor in multivariate analysis. CONCLUSION Preoperative wait time up to 90 days does not affect survival in patients with cStage II/III gastric cancer.
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Affiliation(s)
- Kenichiro Furukawa
- Division of Gastric Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Tomoyuki Irino
- Division of Gastric Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Rie Makuuchi
- Division of Gastric Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Yusuke Koseki
- Division of Gastric Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Kenichi Nakamura
- Division of Gastric Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Yuhei Waki
- Division of Gastric Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Keiichi Fujiya
- Division of Gastric Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Hayato Omori
- Division of Gastric Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Yutaka Tanizawa
- Division of Gastric Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Etsuro Bando
- Division of Gastric Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Taiichi Kawamura
- Division of Gastric Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Masanori Terashima
- Division of Gastric Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan.
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21
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Nishida T, Sugimoto A, Tomita R, Higaki Y, Osugi N, Takahashi K, Mukai K, Matsubara T, Nakamatsu D, Hayashi S, Yamamoto M, Nakajima S, Fukui K, Inada M. Impact of time from diagnosis to chemotherapy in advanced gastric cancer: A Propensity Score Matching Study to Balance Prognostic Factors. World J Gastrointest Oncol 2019; 11:28-38. [PMID: 30984348 PMCID: PMC6451925 DOI: 10.4251/wjgo.v11.i1.28] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 11/21/2018] [Accepted: 12/17/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND It is unclear whether treatment delay affects the clinical outcomes of chemotherapy in advanced gastric cancer (A-GC). AIM To assess whether treatment delay affects the clinical outcomes of chemotherapy in A-GC. METHODS This single-center retrospective study examined consecutive patients with A-GC between April 2012 and July 2018. In total, 110 patients with stage IV A-GC who underwent chemotherapy were enrolled. We defined the wait time (WT) as the interval between diagnosis and chemotherapy initiation. We evaluated the influence of WT on overall survival (OS). RESULTS The mean OS was 303 d. The median WT was 17 d. We divided the patients into early and elective WT groups, with a 2-wk cutoff point. There were 46 and 64 patients in the early and elective WT groups, respectively. Compared with the elective WT group, the early WT group had significantly lower albumin (Alb) levels and higher neutrophil/lymphocyte ratios and C-reactive protein (CRP) levels but not a lower performance status. The elective WT group underwent more combination chemotherapy than did the early WT group. OS was different between the two groups (230 d vs 340 d, respectively). Multivariate analysis revealed that higher CRP levels, lower Alb levels and monotherapy were significantly related to a poor prognosis. To minimize potential selection bias, patients in the elective WT group were 1:1 propensity score matched with patients in the early WT group; no significant difference in OS was found (303 d vs 311 d, respectively, log-rank P = 0.9832). CONCLUSION A longer WT in patients with A-GC does not appear to be associated with a worse prognosis.
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Affiliation(s)
- Tsutomu Nishida
- Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka 560-8565, Japan
| | - Aya Sugimoto
- Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka 560-8565, Japan
| | - Ryo Tomita
- Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka 560-8565, Japan
| | - Yu Higaki
- Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka 560-8565, Japan
| | - Naoto Osugi
- Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka 560-8565, Japan
| | - Kei Takahashi
- Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka 560-8565, Japan
| | - Kaori Mukai
- Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka 560-8565, Japan
| | - Tokuhiro Matsubara
- Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka 560-8565, Japan
| | - Dai Nakamatsu
- Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka 560-8565, Japan
| | - Shiro Hayashi
- Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka 560-8565, Japan
| | - Masashi Yamamoto
- Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka 560-8565, Japan
| | - Sachiko Nakajima
- Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka 560-8565, Japan
| | - Koji Fukui
- Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka 560-8565, Japan
| | - Masami Inada
- Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka 560-8565, Japan
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22
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Suzuki R, Takagi T, Hikichi T, Sugimoto M, Konno N, Asama H, Watanabe K, Nakamura J, Marubashi S, Ohira H. An observation study of the prognostic effect of waiting times in the management of pancreatic ductal adenocarcinoma. Oncol Lett 2018; 17:587-593. [PMID: 30655805 DOI: 10.3892/ol.2018.9626] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 09/12/2018] [Indexed: 12/22/2022] Open
Abstract
Pancreatic ductal adenocarcinoma (PDAC) is characterized by an aggressive course; therefore, it was hypothesized that waiting times during disease management may serve as a prognostic factor for patients with PDAC. Data for all patients with PDAC who received treatment in Fukushima Medical University Hospital were collected. Median disease-free survival and overall survival time were calculated using the Kaplan-Meier method and utilized as cut-off points to divide the patients into 2 groups: A short and a long survival group. Clinical characteristics, including waiting times, the detection-to-diagnosis waiting time and the diagnosis-to-treatment waiting time, were compared between the 2 survival groups. A total of 149 patients were included in the present study. Among the 72 patients who underwent chemotherapy, no significant differences between the 2 survival groups regarding waiting times were identified; however, the proportion of patients with locally advanced disease and the administration of combination chemotherapy were significantly associated with increased survival. Additionally, no significant differences in the waiting times between the 2 survival groups were identified when evaluating the 79 patients who underwent surgical resection. In conclusion, the results of the present study indicated that detection-to-diagnosis and diagnosis-to-treatment waiting times do not influence the prognosis of patients with PDAC.
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Affiliation(s)
- Rei Suzuki
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Tadayuki Takagi
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Takuto Hikichi
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima 960-1295, Japan
| | - Mitsuru Sugimoto
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Naoki Konno
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Hiroyuki Asama
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Ko Watanabe
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Jun Nakamura
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima 960-1295, Japan
| | - Shigeru Marubashi
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Hiromasa Ohira
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
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23
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Ramey SJ, Asher D, Kwon D, Ahmed AA, Wolfson AH, Yechieli R, Portelance L. Delays in definitive cervical cancer treatment: An analysis of disparities and overall survival impact. Gynecol Oncol 2018; 149:53-62. [PMID: 29605051 DOI: 10.1016/j.ygyno.2017.12.010] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 12/03/2017] [Accepted: 12/07/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Delays in time to treatment initiation (TTI) with definitive radiation therapy (RT) or chemotherapy and RT (CRT) for cervical cancer could lead to poorer outcomes. This study investigates disparities in TTI and the impact of TTI on overall survival (OS). METHODS Adult women with non-metastatic cervical squamous cell carcinoma diagnosed between 2004 and 2014, treated with definitive RT or CRT, and reported to the National Cancer Database were included. TTI was defined as days from diagnosis to start of RT or CRT. The impact of TTI on OS in patients treated with concurrent CRT which included brachytherapy was then assessed. RESULTS Overall, 14,924 patients were included (84.7% CRT, 15.3% RT). TTI was significantly longer for Non-Hispanic Black (NHB) (RR, 1.14; 95% CI, 1.11 to 1.18) and Hispanic women (RR, 1.19; 95% CI, 1.15 to 1.24) compared to Non-Hispanic White (NHW) women. Expected TTI (eTTI) for NHW, NHB, and Hispanic women were 38.1, 45.2, and 49.4days. eTTI rose from 36.2days in 2004 to 44.3days by 2014. Intensity-modulated radiation therapy (IMRT) was associated with increased eTTI of 46.5days versus 40.0days for non-IMRT. Longer TTI was not associated with inferior OS in patients treated with concurrent CRT. CONCLUSIONS Delays in starting RT/CRT for cervical cancer increased from 2004 to 2014. Delays disproportionately affect NHB and Hispanic women. However, increased TTI was not associated with increased mortality for women receiving CRT. Further study of TTI's impact on other endpoints is warranted to determine if TTI represents an important quality indicator.
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Affiliation(s)
- Stephen J Ramey
- Department of Radiation Oncology, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - David Asher
- Department of Radiation Oncology, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Deukwoo Kwon
- Biostatistics and Bioinformatics Shared Resource, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Awad A Ahmed
- Department of Radiation Oncology, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Aaron H Wolfson
- Department of Radiation Oncology, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Raphael Yechieli
- Department of Radiation Oncology, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Lorraine Portelance
- Department of Radiation Oncology, Miller School of Medicine, University of Miami, Miami, FL, United States.
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