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Walker RJB, Choi WJ, Ribeiro T, Habib RA, Zhu A, Tan C, Bui EC, da Costa BR, Karanicolas PJ. Factors Associated With Loss to Follow-Up in Surgical Trials: A Systematic Review and Meta-Analysis. J Surg Res 2024; 300:33-42. [PMID: 38795671 DOI: 10.1016/j.jss.2024.04.054] [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: 08/12/2023] [Revised: 01/19/2024] [Accepted: 04/21/2024] [Indexed: 05/28/2024]
Abstract
INTRODUCTION Loss to follow-up (LTFU) distorts results of randomized controlled trials (RCTs). Understanding trial characteristics that contribute to LTFU may enable investigators to anticipate the extent of LTFU and plan retention strategies. The objective of this systematic review and meta-analysis was to investigate the extent of LTFU in surgical RCTs and evaluate associations between trial characteristics and LTFU. METHODS MEDLINE, Embase, and PubMed Central were searched for surgical RCTs published between January 2002 and December 2021 in the 30 highest impact factor surgical journals. Two-hundred eligible RCTs were randomly selected. The pooled LTFU rate was estimated using random intercept Poisson regression. Associations between trial characteristics and LTFU were assessed using metaregression. RESULTS The 200 RCTs included 37,914 participants and 1307 LTFU events. The pooled LTFU rate was 3.10 participants per 100 patient-years (95% confidence interval [CI] 1.85-5.17). Trial characteristics associated with reduced LTFU were standard-of-care outcome assessments (rate ratio [RR] 0.17; 95% CI 0.06-0.48), surgery for transplantation (RR 0.08; 95% CI 0.01-0.43), and surgery for cancer (RR 0.10; 95% CI 0.02-0.53). Increased LTFU was associated with patient-reported outcomes (RR 14.21; 95% CI 4.82-41.91) and follow-up duration ≥ three months (odds ratio 10.09; 95% CI 4.79-21.28). CONCLUSIONS LTFU in surgical RCTs is uncommon. Participants may be at increased risk of LTFU in trials with outcomes assessed beyond the standard of care, surgical indications other than cancer or transplant, patient-reported outcomes, and longer follow-up. Investigators should consider the impact of design on LTFU and plan retention strategies accordingly.
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Affiliation(s)
- Richard J B Walker
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Canada; Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Woo Jin Choi
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Canada; Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Tiago Ribeiro
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Canada; Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Razan A Habib
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Canada
| | - Alice Zhu
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Canada
| | - Chunyi Tan
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Canada
| | - Evan Chung Bui
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Canada
| | - Bruno R da Costa
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; Applied Health Research Center, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada; Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Paul J Karanicolas
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Canada; Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; Division of General Surgery, Sunnybrook Health Sciences Centre, Toronto, Canada.
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Walker RJB, Easson AM, Hosni A, Kim J, Weiss ES, Santiago AT, Chesney TR, Salit IE. Anal Cancers in Previously Screened Versus Unscreened Patients: Tumor Stage and Treatment Outcomes. Dis Colon Rectum 2024; 67:32-41. [PMID: 37787557 DOI: 10.1097/dcr.0000000000002922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
BACKGROUND Targeted screening programs for patients at high risk for anal squamous-cell carcinoma have been proposed; however, the evidence in support of screening remains unclear. OBJECTIVE This study aimed to determine whether screening high-risk patients (predominantly those living with HIV) detected squamous-cell carcinoma at an earlier stage compared to the routine practice of not screening. DESIGN This is a cohort study. SETTINGS This study was conducted at a quaternary care center in Canada. PATIENTS Included patients were at least 18 years old with a pathologic diagnosis of invasive anal squamous-cell carcinoma between 2002 and 2022. INTERVENTIONS Patients diagnosed through a high-risk screening program were compared to those who did not undergo screening. MAIN OUTCOME MEASURES The primary outcome was clinical stage at presentation, categorized as T1N0M0 vs other. Secondary outcomes included treatments received, treatment failure, and overall survival. RESULTS A total of 612 patients with anal squamous-cell carcinoma were included, with 26 of those patients diagnosed through a screening program. Patients with screen-detected cancers had greater odds of presenting with T1N0M0 tumors compared to unscreened patients (18 [69.2%] vs 84 [14.3%]; adjusted OR 9.95; 95% CI, 3.95-25.08). A propensity score-matched sensitivity analysis found similar results (OR 11.13; 95% CI, 4.67-26.52). Screened patients had greater odds of treatment with wide local excision alone, as opposed to any combination of chemotherapy, radiation therapy, and surgery (3 [12.5%] vs 18 [3.2%]; OR 4.38; 95% CI, 1.20-16.04). There were no statistically significant differences in treatment failure or overall survival between groups. LIMITATIONS The small number of screened patients limits the power of the analysis. CONCLUSIONS Screening for anal squamous-cell carcinoma among high-risk populations detects cancers at an earlier stage. Patients with screen-detected cancers also had a greater likelihood of being candidates for wide local excision alone, which may have spared them the morbidity associated with chemoradiotherapy or abdominoperineal resection. See Video Abstract. CNCERES DE ANO EN PACIENTES PREVIAMENTE DETECTADOS POR CRIBADO VERSUS NO DETECTADOS ESTADIO DEL TUMOR Y RESULTADOS DEL TRATAMIENTO ANTECEDENTES:Se han propuesto programas de cribado dirigidos a pacientes con alto riesgo de carcinoma anal de células escamosas; sin embargo, la evidencia a favor de la detección sigue sin estar clara.OBJETIVO:Este estudio tuvo como objetivo determinar si el cribado de pacientes de alto riesgo (predominantemente aquellos que viven con el VIH) detectó el carcinoma de células escamosas en una etapa más temprana en comparación con la práctica habitual de no cribado.DISEÑO:Este es un estudio de cohortes.CONFIGURACIÓN:Este estudio se realizó en un centro de atención cuaternaria en Canadá.PACIENTES:Los pacientes incluidos tenían al menos 18 años con un diagnóstico patológico de carcinoma de células escamosas anal invasivo entre 2002 y 2022.INTERVENCIONES:Los pacientes diagnosticados mediante un programa de cribado de alto riesgo se compararon con aquellos que no se sometieron a cribado.PRINCIPALES MEDIDAS DE RESULTADO:El resultado primario fue el estadio clínico en la presentación, categorizado como T1N0M0 versus otro. Los resultados secundarios incluyeron los tratamientos recibidos, el fracaso del tratamiento y la supervivencia general.RESULTADOS:Se incluyeron un total de 612 pacientes con carcinoma anal de células escamosas, con 26 de esos pacientes diagnosticados a través de un programa de cribado. Los pacientes con cánceres detectados mediante cribado tenían mayores probabilidades de presentar tumores T1N0M0 en comparación con los pacientes no cribados (18 [69.2%] frente a 84 [14.3%]; razón de probabilidad ajustada 9.95; intervalo de confianza del 95 % 3.95 -25.08). Un análisis de sensibilidad emparejado por puntaje de propensión encontró resultados similares (odds ratio 11.13; intervalo de confianza del 95% 4.67 -26.52; p < 0.001). Los pacientes examinados tenían mayores probabilidades de recibir tratamiento con escisión local amplia sola, en comparación con cualquier combinación de quimioterapia, radiación y cirugía (3 [12.5%] frente a 18 [3.2%]; razón de probabilidad 4.38; intervalo de confianza del 95 % 1.20 -16.04). No hubo diferencias estadísticamente significativas en el fracaso del tratamiento o la supervivencia global entre los grupos.LIMITACIONES:El pequeño número de pacientes evaluados limita el poder del análisis.CONCLUSIONES:La detección del carcinoma anal de células escamosas entre las poblaciones de alto riesgo detecta los cánceres en una etapa más temprana. Los pacientes con cánceres detectados mediante cribado también tenían una mayor probabilidad de ser candidatos para una escisión local amplia sola, lo que puede haberles evitado la morbilidad asociada con la quimiorradioterapia o la resección abdominoperineal. (Traducción --Dr. Aurian Garcia Gonzalez ).
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Affiliation(s)
- Richard J B Walker
- Department of Surgery, University Health Network, Toronto, Ontario, Canada
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Alexandra M Easson
- Department of Surgery, University Health Network, Toronto, Ontario, Canada
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Department of Surgical Oncology, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Ali Hosni
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - John Kim
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Edward S Weiss
- Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Anna T Santiago
- Department of Biostatistics, University Health Network, Toronto, Ontario, Canada
| | - Tyler R Chesney
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Department of Surgery, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Irving E Salit
- Department of Medicine, University Health Network, Toronto, Ontario, Canada
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Hughes BR, Shanaz S, Ismail-Sutton S, Wreglesworth NI, Subbe CP, Innominato PF. Circadian lifestyle determinants of immune checkpoint inhibitor efficacy. Front Oncol 2023; 13:1284089. [PMID: 38111535 PMCID: PMC10727689 DOI: 10.3389/fonc.2023.1284089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 11/07/2023] [Indexed: 12/20/2023] Open
Abstract
Immune Checkpoint Inhibitors (ICI) have revolutionised cancer care in recent years. Despite a global improvement in the efficacy and tolerability of systemic anticancer treatments, a sizeable proportion of patients still do not benefit maximally from ICI. Extensive research has been undertaken to reveal the immune- and cancer-related mechanisms underlying resistance and response to ICI, yet more limited investigations have explored potentially modifiable lifestyle host factors and their impact on ICI efficacy and tolerability. Moreover, multiple trials have reported a marked and coherent effect of time-of-day ICI administration and patients' outcomes. The biological circadian clock indeed temporally controls multiple aspects of the immune system, both directly and through mediation of timing of lifestyle actions, including food intake, physical exercise, exposure to bright light and sleep. These factors potentially modulate the immune response also through the microbiome, emerging as an important mediator of a patient's immune system. Thus, this review will look at critically amalgamating the existing clinical and experimental evidence to postulate how modifiable lifestyle factors could be used to improve the outcomes of cancer patients on immunotherapy through appropriate and individualised entrainment of the circadian timing system and temporal orchestration of the immune system functions.
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Affiliation(s)
- Bethan R. Hughes
- Oncology Department, Ysbyty Gwynedd, Betsi Cadwaladr University Health Board, Bangor, United Kingdom
- School of Medical Sciences, Bangor University, Bangor, United Kingdom
| | - Sadiq Shanaz
- Oncology Department, Ysbyty Gwynedd, Betsi Cadwaladr University Health Board, Bangor, United Kingdom
| | - Seline Ismail-Sutton
- Oncology Department, Ysbyty Gwynedd, Betsi Cadwaladr University Health Board, Bangor, United Kingdom
| | - Nicholas I. Wreglesworth
- Oncology Department, Ysbyty Gwynedd, Betsi Cadwaladr University Health Board, Bangor, United Kingdom
- School of Medical Sciences, Bangor University, Bangor, United Kingdom
| | - Christian P. Subbe
- School of Medical Sciences, Bangor University, Bangor, United Kingdom
- Department of Acute Medicine, Ysbyty Gwynedd, Bangor, United Kingdom
| | - Pasquale F. Innominato
- Oncology Department, Ysbyty Gwynedd, Betsi Cadwaladr University Health Board, Bangor, United Kingdom
- Cancer Chronotherapy Team, Warwick Medical School, University of Warwick, Coventry, United Kingdom
- Research Unit ‘Chronotherapy, Cancers and Transplantation’, Faculty of Medicine, Paris-Saclay University, Villejuif, France
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Paunescu AC, Préau M, Jacob G, Pannard M, Delrieu L, Delpierre C, Kvaskoff M. Health behaviour changes in female cancer survivors: The Seintinelles study. Bull Cancer 2023; 110:496-511. [PMID: 36922320 DOI: 10.1016/j.bulcan.2023.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 01/20/2023] [Accepted: 02/03/2023] [Indexed: 03/16/2023]
Abstract
INTRODUCTION The number of cancer survivors increases and their risks of recurrence, second cancer, morbidity and death is high; measures to prevent these risks are thus critical. Knowing the factors that lead cancer survivor to adopt or not healthy behaviours is crucial for designing effective prevention campaigns and better support them in after-cancer. Our study attempts to provide additional knowledge in this direction. METHODS This retrospective study was conducted via the Seintinelles collaborative research platform in a community of women with cancer volunteering to take online questionnaires. We collected data on sociodemographic factors and health, knowledge of cancer risk factors, and possible behaviour changes (tobacco/alcohol use, diet, physical activity) after cancer diagnosis. RESULTS The study involved 1180 women aged between 26 and 79 years. Several cancer-related factors (cancer other than breast cancer, longer time since diagnosis, taking drug treatment for cancer, sequelae, negative evolution of the cancer) favoured certain positive changes in behaviour. Sociodemographic factors (age, habitat environment, currently employed, living status, dependent children) or factors related to health (general condition, presence of comorbidities, neurological problems, hospitalizations, body mass index) favoured or not certain changes in behaviour. Lack of knowledge about modifiable risk factors for cancer was associated with not adopting healthy behaviours after cancer. DISCUSSION This study made it possible to identify important elements to be addressed in order to improve cancer risk prevention messages.
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Affiliation(s)
| | - Marie Préau
- Institut de psychologie, UR GRePS, Université Lumière Lyon 2, Bron, France
| | - Guillemette Jacob
- Association « Seintinelles. Contre le cancer, tous volontaires », 40, rue Rémy-Dumoncel, 75014 Paris, France
| | - Myriam Pannard
- Institut de psychologie, UR GRePS, Université Lumière Lyon 2, Bron, France
| | - Lidia Delrieu
- Association « Seintinelles. Contre le cancer, tous volontaires », 40, rue Rémy-Dumoncel, 75014 Paris, France; Paris University, Institut Curie, Residual Tumor & Response to Treatment Laboratory, RT2Lab, Inserm, U932 Immunity and Cancer, Translational Research Department, Paris, France
| | - Cyrille Delpierre
- CERPOP UMR1295, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - Marina Kvaskoff
- Inserm CESP U1018, Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif, France
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Johnston EA, Ekberg S, Jennings B, Jagasia N, van der Pols JC, Webb PM. Dietary practices after primary treatment for ovarian cancer: A qualitative analysis from the OPAL Study. J Acad Nutr Diet 2022; 122:1607-1628.e12. [PMID: 35595188 DOI: 10.1016/j.jand.2022.05.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 04/22/2022] [Accepted: 05/12/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Little is known about dietary practices of women who have completed primary treatment for ovarian cancer, many of whom will go on to experience cancer recurrence and have further treatment. Knowledge of dietary practices is needed to optimize care. OBJECTIVE To identify dietary practices after primary treatment for ovarian cancer and evaluate how these practices differ by disease recurrence and treatment status. DESIGN Women with invasive epithelial ovarian cancer were provided with an open-ended question after completing a food frequency questionnaire (FFQ): "Is there anything we haven't asked you about your diet in the last 1-2 months that you feel is important?" PARTICIPANTS/SETTING Participants in the Ovarian cancer Prognosis And Lifestyle (OPAL) Study in Australia. MAIN OUTCOMES Dietary practices after primary treatment for ovarian cancer and factors affecting these practices. ANALYSIS Participants' responses were analyzed using content analysis. Individual content codes were categorized and reported by recurrence and treatment status at questionnaire completion. RESULTS 286 women provided responses on 363 questionnaires. Those undergoing further treatment for recurrence commonly reported dietary regimens with clinical indications (e.g., low fiber to avoid bowel obstructions, high energy/protein to minimize nutritional deficits). Those not undergoing further treatment frequently reported 'popular' diets (e.g., organic, plant-based, alkaline). For women with cancer recurrence, dietary practices were affected by poor appetite and treatment late effects. For women without recurrence, other comorbidities, geographical location, family and friends appeared to influence dietary practices. In both groups, nutrition information sources and personal beliefs informed dietary practices. Participant responses that referenced media or online sources often included misinformation. CONCLUSIONS Following primary treatment for ovarian cancer, women report dietary practices that may not be captured in standard FFQs. Dietary practices and factors affecting these practices likely differ by treatment and recurrence status. Improved access to evidence-based dietary information and support is needed.
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Affiliation(s)
- Elizabeth A Johnston
- PhD Candidate, Queensland University of Technology, School of Exercise and Nutrition Sciences, Brisbane, Queensland, Australia; Visiting PhD Student, QIMR Berghofer Medical Research Institute, Population Health Department, Brisbane, Queensland, Australia; Early Career Research Fellow, Viertel Cancer Research Centre, Cancer Council Queensland, Fortitude Valley, Queensland, Australia
| | - Stuart Ekberg
- Queensland University of Technology, School of Psychology and Counselling, Brisbane, Queensland, Australia
| | - Bronwyn Jennings
- Gynecology Oncology Clinical Nurse Consultant, Mater Hospital Brisbane, Department of Gynaeoncology, Brisbane, Queensland, Australia
| | - Nisha Jagasia
- Gynecological Oncologist, Mater Hospital Brisbane, Department of Gynaeoncology, Brisbane, Queensland, Australia
| | - Jolieke C van der Pols
- Queensland University of Technology, School of Exercise and Nutrition Sciences, Brisbane, Queensland, Australia; Visiting Scientist, QIMR Berghofer Medical Research Institute, Population Health Department, Brisbane, Queensland, Australia
| | - Penelope M Webb
- QIMR Berghofer Medical Research Institute, Population Health Department, Brisbane, Queensland, Australia;; Adjunct Professor, Queensland University of Technology, School of Public Health and Social Work, Brisbane, Queensland, Australia
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