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Update on Prevalence of Pain in Patients with Cancer 2022: A Systematic Literature Review and Meta-Analysis. Cancers (Basel) 2023; 15:cancers15030591. [PMID: 36765547 PMCID: PMC9913127 DOI: 10.3390/cancers15030591] [Citation(s) in RCA: 69] [Impact Index Per Article: 69.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/13/2023] [Accepted: 01/14/2023] [Indexed: 01/20/2023] Open
Abstract
Experiencing pain and insufficient relief can be devastating and negatively affect a patient's quality of life. Developments in oncology such as new treatments and adjusted pain management guidelines may have influenced the prevalence of cancer pain and severity in patients. This review aims to provide an overview of the prevalence and severity of pain in cancer patients in the 2014-2021 literature period. A systematic literature search was performed using the databases PubMed, Embase, CINAHL, and Cochrane. Titles and abstracts were screened, and full texts were evaluated and assessed on methodological quality. A meta-analysis was performed on the pooled prevalence and severity rates. A meta-regression analysis was used to explore differences between treatment groups. We identified 10,637 studies, of which 444 studies were included. The overall prevalence of pain was 44.5%. Moderate to severe pain was experienced by 30.6% of the patients, a lower proportion compared to previous research. Pain experienced by cancer survivors was significantly lower compared to most treatment groups. Our results imply that both the prevalence of pain and pain severity declined in the past decade. Increased attention to the assessment and management of pain might have fostered the decline in the prevalence and severity of pain.
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A Calculator for COVID-19 Severity Prediction Based on Patient Risk Factors and Number of Vaccines Received. Microorganisms 2022; 10:microorganisms10061238. [PMID: 35744754 PMCID: PMC9229599 DOI: 10.3390/microorganisms10061238] [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: 05/25/2022] [Revised: 06/14/2022] [Accepted: 06/14/2022] [Indexed: 11/16/2022] Open
Abstract
Vaccines have allowed for a significant decrease in COVID-19 risk, and new antiviral medications can prevent disease progression if given early in the course of the disease. The rapid and accurate estimation of the risk of severe disease in new patients is needed to prioritize the treatment of high-risk patients and maximize lives saved. We used electronic health records from 101,039 individuals infected with SARS-CoV-2, since the beginning of the pandemic and until 30 November 2021, in a national healthcare organization in Israel to build logistic models estimating the probability of subsequent hospitalization and death of newly infected patients based on a few major risk factors (age, sex, body mass index, hemoglobin A1C, kidney function, and the presence of hypertension, pulmonary disease, and malignancy) and the number of BNT162b2 mRNA vaccine doses received. The model’s performance was assessed by 10-fold cross-validation: the area under the curve was 0.889 for predicting hospitalization and 0.967 for predicting mortality. A total of 50%, 80%, and 90% of death events could be predicted with respective specificities of 98.6%, 95.2%, and 91.2%. These models enable the rapid identification of individuals at high risk for hospitalization and death when infected, and they can be used to prioritize patients to receive scarce medications or booster vaccination. The calculator is available online.
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Clinical and Laboratory Features in the Israeli Population with COVID-19 Infection after Pfizer-BioNTech mRNA Booster Vaccination. Vaccines (Basel) 2022; 10:vaccines10050636. [PMID: 35632392 PMCID: PMC9145987 DOI: 10.3390/vaccines10050636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 04/05/2022] [Accepted: 04/13/2022] [Indexed: 02/06/2023] Open
Abstract
Background: Immune protection following either vaccination or infection with SARS-CoV-2 decreases over time. Objective: We aim to describe clinical and sociodemographic characteristics associated with COVID-19 infection at least 14 days after booster vaccination in the Israeli population. Methods: We conducted a population-based study among adult members of Leumit Health Services (LHS) in Israel. Nasopharyngeal swabs were examined for SARS-CoV-2 by real-time RT-PCR. The hematological and biochemical parameters in the peripheral blood before booster vaccination were evaluated. Results: Between 1 February 2021 and 30 November 2021, 136,683 individuals in LHS were vaccinated with a booster (third dose) of the BNT162b2 vaccine. Of these, 1171 (0.9%) were diagnosed with COVID-19 by testing positive for SARS-CoV-2 RT-PCR at least >14 days after the booster vaccination. The COVID-19-positive group was characterized by higher rates of chronic kidney disease than the matched COVID-19-negative group (43 (3.7%) vs. 3646 (2.7%); p = 0.039). Anemia, lower peripheral blood lymphocytes, monocytes, basophils, C3 Complement, cholesterol, and prothrombin time were also associated with COVID-19 after booster vaccination. Conclusion: People with chronic kidney disease and anemia should be included in possible future annual SARS-CoV-2 vaccination recommendations.
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Israel A, Schäffer AA, Merzon E, Green I, Magen E, Golan-Cohen A, Vinker S, Ruppin E. Predicting COVID-19 severity using major risk factors and received vaccines. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2022:2021.12.31.21268575. [PMID: 35018390 PMCID: PMC8750716 DOI: 10.1101/2021.12.31.21268575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Vaccines are highly effective in preventing severe disease and death from COVID-19, and new medications that can reduce severity of disease have been approved. However, many countries are facing limited supply of vaccine doses and medications. A model estimating the probabilities for hospitalization and mortality according to individual risk factors and vaccine doses received could help prioritize vaccination and yet scarce medications to maximize lives saved and reduce the burden on hospitalization facilities. METHODS Electronic health records from 101,039 individuals infected with SARS-CoV-2, since the beginning of the pandemic and until November 30, 2021 were extracted from a national healthcare organization in Israel. Logistic regression models were built to estimate the risk for subsequent hospitalization and death based on the number of BNT162b2 mRNA vaccine doses received and few major risk factors (age, sex, body mass index, hemoglobin A1C, kidney function, and presence of hypertension, pulmonary disease and malignancy). RESULTS The models built predict the outcome of newly infected individuals with remarkable accuracy: area under the curve was 0.889 for predicting hospitalization, and 0.967 for predicting mortality. Even when a breakthrough infection occurs, having received three vaccination doses significantly reduces the risk of hospitalization by 66% (OR=0.339) and of death by 78% (OR=0.223). CONCLUSIONS The models enable rapid identification of individuals at high risk for hospitalization and death when infected. These patients can be prioritized to receive booster vaccination and the yet scarce medications. A calculator based on these models is made publicly available on http://covidest.web.app.
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Affiliation(s)
| | - Alejandro A. Schäffer
- Cancer Data Science Laboratory, Center for Cancer Research, National Cancer Institute, Bethesda, MD USA
| | - Eugene Merzon
- Leumit Health Services, Israel
- Adelson School of Medicine, Ariel University, Ariel, Israel
| | - Ilan Green
- Leumit Health Services, Israel
- Department of Family Medicine, Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Eli Magen
- Leumit Health Services, Israel
- Medicine C Department, Clinical Immunology and Allergy Division, Barzilai University Medical Center, Ben-Gurion University of the Negev, Ashkelon, Israel
| | - Avivit Golan-Cohen
- Leumit Health Services, Israel
- Department of Family Medicine, Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Shlomo Vinker
- Leumit Health Services, Israel
- Department of Family Medicine, Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Eytan Ruppin
- Cancer Data Science Laboratory, Center for Cancer Research, National Cancer Institute, Bethesda, MD USA
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Israel A, Shenhar Y, Green I, Merzon E, Golan-Cohen A, Schäffer AA, Ruppin E, Vinker S, Magen E. Large-Scale Study of Antibody Titer Decay following BNT162b2 mRNA Vaccine or SARS-CoV-2 Infection. Vaccines (Basel) 2021; 10:vaccines10010064. [PMID: 35062724 PMCID: PMC8781423 DOI: 10.3390/vaccines10010064] [Citation(s) in RCA: 101] [Impact Index Per Article: 33.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 12/24/2021] [Accepted: 12/28/2021] [Indexed: 12/19/2022] Open
Abstract
Immune protection following either vaccination or infection with SARS-CoV-2 is thought to decrease over time. We designed a retrospective study, conducted at Leumit Health Services in Israel, to determine the kinetics of SARS-CoV-2 IgG antibodies following administration of two doses of BNT162b2 vaccine, or SARS-CoV-2 infection in unvaccinated individuals. Antibody titers were measured between 31 January 2021, and 31 July 2021 in two mutually exclusive groups: (i) vaccinated individuals who received two doses of BNT162b2 vaccine and had no history of previous infection with COVID-19 and (ii) SARS-CoV-2 convalescents who had not received the vaccine. A total of 2653 individuals fully vaccinated by two doses of vaccine during the study period and 4361 convalescent patients were included. Higher SARS-CoV-2 IgG antibody titers were observed in vaccinated individuals (median 1581 AU/mL IQR [533.8–5644.6]) after the second vaccination than in convalescent individuals (median 355.3 AU/mL IQR [141.2–998.7]; p < 0.001). In vaccinated subjects, antibody titers decreased by up to 38% each subsequent month while in convalescents they decreased by less than 5% per month. Six months after BNT162b2 vaccination 16.1% subjects had antibody levels below the seropositivity threshold of <50 AU/mL, while only 10.8% of convalescent patients were below <50 AU/mL threshold after 9 months from SARS-CoV-2 infection. This study demonstrates individuals who received the Pfizer-BioNTech mRNA vaccine have different kinetics of antibody levels compared to patients who had been infected with the SARS-CoV-2 virus, with higher initial levels but a much faster exponential decrease in the first group.
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Affiliation(s)
- Ariel Israel
- Leumit Research Institute & Department of Family Medicine, Leumit Health Services, Tel Aviv 6473817, Israel; (Y.S.); (I.G.); (E.M.); (A.G.-C.); (S.V.); (E.M.)
- Correspondence: ; Tel.: +972-3-697-0485
| | - Yotam Shenhar
- Leumit Research Institute & Department of Family Medicine, Leumit Health Services, Tel Aviv 6473817, Israel; (Y.S.); (I.G.); (E.M.); (A.G.-C.); (S.V.); (E.M.)
| | - Ilan Green
- Leumit Research Institute & Department of Family Medicine, Leumit Health Services, Tel Aviv 6473817, Israel; (Y.S.); (I.G.); (E.M.); (A.G.-C.); (S.V.); (E.M.)
- Department of Family Medicine, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv 69978, Israel
| | - Eugene Merzon
- Leumit Research Institute & Department of Family Medicine, Leumit Health Services, Tel Aviv 6473817, Israel; (Y.S.); (I.G.); (E.M.); (A.G.-C.); (S.V.); (E.M.)
- Department of Family Medicine, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv 69978, Israel
| | - Avivit Golan-Cohen
- Leumit Research Institute & Department of Family Medicine, Leumit Health Services, Tel Aviv 6473817, Israel; (Y.S.); (I.G.); (E.M.); (A.G.-C.); (S.V.); (E.M.)
- Department of Family Medicine, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv 69978, Israel
| | - Alejandro A. Schäffer
- Cancer Data Science Laboratory, National Cancer Institute, Bethesda, MD 20892, USA; (A.A.S.); (E.R.)
| | - Eytan Ruppin
- Cancer Data Science Laboratory, National Cancer Institute, Bethesda, MD 20892, USA; (A.A.S.); (E.R.)
| | - Shlomo Vinker
- Leumit Research Institute & Department of Family Medicine, Leumit Health Services, Tel Aviv 6473817, Israel; (Y.S.); (I.G.); (E.M.); (A.G.-C.); (S.V.); (E.M.)
- Department of Family Medicine, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv 69978, Israel
| | - Eli Magen
- Leumit Research Institute & Department of Family Medicine, Leumit Health Services, Tel Aviv 6473817, Israel; (Y.S.); (I.G.); (E.M.); (A.G.-C.); (S.V.); (E.M.)
- Medicine C Department, Clinical Immunology and Allergy Division, Barzilai University Medical Center, Ben Gurion University of the Negev, Ashkelon 7830604, Israel
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Israel A, Merzon E, Schäffer AA, Shenhar Y, Green I, Golan-Cohen A, Ruppin E, Magen E, Vinker S. Elapsed time since BNT162b2 vaccine and risk of SARS-CoV-2 infection: test negative design study. BMJ 2021; 375:e067873. [PMID: 34819275 PMCID: PMC9083235 DOI: 10.1136/bmj-2021-067873] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To determine whether time elapsed since the second injection of the Pfizer-BioNTech BNT162b2 mRNA vaccine was significantly associated with the risk of covid-19 infection after vaccination in people who received two vaccine injections. DESIGN Test negative design study. SETTING Electronic health records of a large state mandated healthcare organisation, Israel. PARTICIPANTS Adults aged ≥18 years who had received a reverse transcription polymerase chain reaction (RT-PCR) test between 15 May 2021 and 17 September 2021, at least three weeks after their second vaccine injection, had not received a third vaccine injection, and had no history of covid-19 infection. MAIN OUTCOME MEASURES Positive result for the RT-PCR test. Individuals who tested positive for SARS-CoV-2 and controls were matched for week of testing, age category, and demographic group (ultra-orthodox Jews, individuals of Arab ancestry, and the general population). Conditional logistic regression was adjusted for age, sex, socioeconomic status, and comorbid conditions. RESULTS 83 057 adults received an RT-PCR test for SARS-CoV-2 during the study period and 9.6% had a positive result. Time elapsed since the vaccine injection was significantly longer in individuals who tested positive (P<0.001). Adjusted odds ratio for infection at time intervals >90 days since vaccination were significantly increased compared with the reference of <90 days: 2.37 (95% confidence interval 1.67 to 3.36) for 90-119 days, 2.66 (1.94 to 3.66) for 120-149 days, 2.82 (2.07 to 3.84) for 150-179 days, and 2.82 (2.07 to 3.85) for ≥180 days (P<0.001 for each 30 day interval). CONCLUSIONS In this large population of adults tested for SARS-CoV-2 by RT-PCR after two doses of mRNA BNT162b2 vaccine, a gradual increase in the risk of infection was seen for individuals who received their second vaccine dose after at least 90 days.
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Affiliation(s)
| | - Eugene Merzon
- Leumit Health Services, Tel Aviv, Israel
- Adelson School of Medicine, Ariel University, Ariel, Israel
| | | | | | - Ilan Green
- Leumit Health Services, Tel Aviv, Israel
- Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Avivit Golan-Cohen
- Leumit Health Services, Tel Aviv, Israel
- Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eytan Ruppin
- Cancer Data Science Laboratory, National Cancer Institute, Bethesda, MD, USA
| | - Eli Magen
- Leumit Health Services, Tel Aviv, Israel
- Medicine C Department, Clinical Immunology and Allergy Division, Barzilai University Medical Centre, Ben-Gurion University of the Negev, Ashkelon, Israel
| | - Shlomo Vinker
- Leumit Health Services, Tel Aviv, Israel
- Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Selçuk H, Roos EM, Grønne DT, Ernst MT, Skou ST. Agreement Between Self-Reported Information and Administrative Data on Comorbidities, Imaging and Treatment in Denmark - A Validation Study of 38,745 Patients with Knee or Hip Osteoarthritis. Clin Epidemiol 2021; 13:779-790. [PMID: 34512031 PMCID: PMC8416180 DOI: 10.2147/clep.s309364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 07/07/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To validate self-reported information obtained from patients with knee or hip osteoarthritis (OA) in primary care against administrative data from the three national Danish registries. Patients and Methods We compared the baseline and 12-month follow-up data from 38,745 patients with knee or hip OA participating in the Good Life with osteoArthritis in Denmark (GLA:D®) program with registry-based data on joint surgeries, pain medication dispensing, radiographs, and hospital diagnoses. Agreement was calculated using Cohen's Kappa (k) and percentage agreement, both with 95% CI. Results There was a moderate agreement between self-report and registry-based data for previous knee surgery (k=0.58, 84.99%) and a substantial agreement for previous hip surgery (k=0.73, 97.05%). Agreement varied from 0.05 to 0.95 and 84.99% to 99.94% for different types of surgeries with lowest agreement for collateral ligament surgery (k=0.05, 99.82%) and highest agreement for joint replacement (k=0.95, 99.54% for knee; k=0.95, 99.48% for hip). There was a moderate agreement (k=0.41, 81.59%) for knee and a slight agreement (k=0.20, 64.79%) for hip radiographs. Agreement varied from 0.01 to 0.53 and 65.39% to 99.90% for pain medication with lowest agreement for topical NSAID (k=0.01, 95.00%) and highest agreement for opioids (k=0.53, 92.56%). For comorbidities, agreement varied from 0.14 to 0.90 and 78.07% to 98.91%, with lowest agreement for anemia or other blood disease (k=0.14, 97.63%) and highest agreement for diabetes (k=0.90, 98.73%). Conclusion As the most common types of pain medication used by patients with OA can be bought over-the-counter and as most OA patients are treated in primary care, which is often not covered by national registries, self-report of pain medication use and comorbidities is preferred but cannot be sufficiently validated against registry-based data. Future studies collecting self-reported information on joint surgery and pain medication from patients with OA should use a less detailed categorization to improve accuracy.
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Affiliation(s)
- Halit Selçuk
- Department of Physiotherapy and Rehabilitation, Marmara University, İstanbul, Turkey
| | - Ewa M Roos
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Dorte T Grønne
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Martin T Ernst
- Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Søren T Skou
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Naestved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
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Israel A, Shenhar Y, Green I, Merzon E, Golan-Cohen A, Schäffer AA, Ruppin E, Vinker S, Magen E. Large-scale study of antibody titer decay following BNT162b2 mRNA vaccine or SARS-CoV-2 infection. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2021:2021.08.19.21262111. [PMID: 34462761 PMCID: PMC8404903 DOI: 10.1101/2021.08.19.21262111] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Immune protection following either vaccination or infection with SARS-CoV-2 decreases over time. OBJECTIVE To determine the kinetics of SARS-CoV-2 IgG antibodies following administration of two doses of BNT162b2 vaccine, or SARS-CoV-2 infection in unvaccinated individuals. METHODS Antibody titers were measured between January 31, 2021, and July 31, 2021 in two mutually exclusive groups: i) vaccinated individuals who received two doses of BNT162b2 vaccine and had no history of previous infection with COVID-19 and ii) SARS-CoV-2 convalescents who had not received the vaccine. RESULTS A total of 2,653 individuals fully vaccinated by two doses of vaccine during the study period and 4,361 convalescent patients were included. Higher SARS-CoV-2 IgG antibody titers were observed in vaccinated individuals (median 1581 AU/mL IQR [533.8-5644.6]) after the second vaccination, than in convalescent individuals (median 355.3 AU/mL IQR [141.2-998.7]; p<0.001). In vaccinated subjects, antibody titers decreased by up to 40% each subsequent month while in convalescents they decreased by less than 5% per month. Six months after BNT162b2 vaccination 16.1% subjects had antibody levels below the seropositivity threshold of <50 AU/mL, while only 10.8% of convalescent patients were below <50 AU/mL threshold after 9 months from SARS-CoV-2 infection. CONCLUSIONS This study demonstrates individuals who received the Pfizer-BioNTech mRNA vaccine have different kinetics of antibody levels compared to patients who had been infected with the SARS-CoV-2 virus, with higher initial levels but a much faster exponential decrease in the first group. FUNDING This research was internally funded by Leumit Health Services (LHS) and was supported in part by the Intramural Research Program, National Institutes of Health, National Cancer Institute, Center for Cancer Research.The content of this publication does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government. IMPACT STATEMENT Large scale study display the kinetics of SARS-CoV-2 IgG antibodies present in individuals vaccinated with two doses of mRNA vaccine vs. unvaccinated patients who had recovered from the disease: initial levels of antibody are much higher in vaccinated patients, but decrease faster.
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Affiliation(s)
- Ariel Israel
- Leumit Research Institute & Department of Family Medicine, Leumit Health Services, Israel
| | - Yotam Shenhar
- Leumit Research Institute & Department of Family Medicine, Leumit Health Services, Israel
| | - Ilan Green
- Leumit Research Institute & Department of Family Medicine, Leumit Health Services, Israel
- Department of Family Medicine, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Eugene Merzon
- Leumit Research Institute & Department of Family Medicine, Leumit Health Services, Israel
- Department of Family Medicine, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Avivit Golan-Cohen
- Leumit Research Institute & Department of Family Medicine, Leumit Health Services, Israel
- Department of Family Medicine, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | | | - Eytan Ruppin
- Cancer Data Science Laboratory, National Cancer Institute, Bethesda, MD USA
| | - Shlomo Vinker
- Leumit Research Institute & Department of Family Medicine, Leumit Health Services, Israel
- Department of Family Medicine, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Eli Magen
- Leumit Research Institute & Department of Family Medicine, Leumit Health Services, Israel
- Medicine C Department, Clinical Immunology and Allergy Division, Barzilai University Medical Center, Ben Gurion University of the Negev, Israel
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Israel A, Merzon E, Schäffer AA, Shenhar Y, Green I, Golan-Cohen A, Ruppin E, Magen E, Vinker S. Elapsed time since BNT162b2 vaccine and risk of SARS-CoV-2 infection in a large cohort. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2021. [PMID: 34401882 PMCID: PMC8366798 DOI: 10.1101/2021.08.03.21261496] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Importance: Israel was among the first countries to launch a large-scale COVID-19 vaccination campaign, and quickly vaccinated its population, achieving early control over the spread of the virus. However, the number of COVID-19 cases is now rapidly increasing, which may indicate that vaccine protection decreases over time. Objective: To determine whether time elapsed since the second BNT162b2 messenger RNA (mRNA) vaccine (Pfizer-BioNTech) injection is significantly associated with the risk of post-vaccination COVID-19 infection. Design: This is a retrospective cohort study performed in a large state-mandated health care organization in Israel. Participants: All fully vaccinated adults who have received a RT-PCR test between May 15, 2021 and July 26, 2021, at least two weeks after their second vaccine injection were included. Patients with a history of past COVID-19 infection were excluded. Main Outcome and Measure: Positive result for the RT-PCR test. Results: The cohort included 33,993 fully vaccinated adults, 49% women, with a mean age of 47 years (SD, 17 years), who received an RT-PCR test for SARS-CoV-2 during the study period. The median time between the second dose of the vaccine and the RT-PCR test was 146 days, interquartile range [121–167] days. 608 (1.8%) patients had positive test results. There was a significantly higher rate of positive results among patients who received their second vaccine dose at least 146 days before the RT-PCR test compared to patients who have received their vaccine less than 146 days before: odds ratio for infection was 3.00 for patients aged over 60 (95% CI 1.86–5.11); 2.29 for patients aged between 40 and 59 (95% CI 1.67–3.17); and 1.74 for patients aged between 18 and 39 (95% CI 1.27–2.37); P<0.001 in each age group. Conclusions and Relevance: In this large population study of patients tested for SARS-CoV-2 by RT-PCR following two doses of mRNA BNT162b2 vaccine, we observe a significant increase of the risk of infection in individuals who received their last vaccine dose since at least 146 days ago, particularly among patients older than 60.
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Affiliation(s)
- Ariel Israel
- Leumit Research Institute & Department of Family Medicine, Leumit Health Services, Israel
| | - Eugene Merzon
- Leumit Research Institute & Department of Family Medicine, Leumit Health Services, Israel.,Department of Family Medicine, Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | | | - Yotam Shenhar
- Leumit Research Institute & Department of Family Medicine, Leumit Health Services, Israel
| | - Ilan Green
- Leumit Research Institute & Department of Family Medicine, Leumit Health Services, Israel.,Department of Family Medicine, Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Avivit Golan-Cohen
- Leumit Research Institute & Department of Family Medicine, Leumit Health Services, Israel.,Department of Family Medicine, Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Eytan Ruppin
- Cancer Data Science Laboratory, National Cancer Institute, Bethesda, MD USA
| | - Eli Magen
- Leumit Research Institute & Department of Family Medicine, Leumit Health Services, Israel.,Medicine C Department, Clinical Immunology and Allergy Division, Barzilai University Medical Center, Ben-Gurion University of the Negev, Ashkelon, Israel
| | - Shlomo Vinker
- Leumit Research Institute & Department of Family Medicine, Leumit Health Services, Israel.,Department of Family Medicine, Sackler Faculty of Medicine, Tel-Aviv University, Israel
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COVID-19 Susceptibility in Bronchial Asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 9:684-692.e1. [PMID: 33242628 PMCID: PMC7683297 DOI: 10.1016/j.jaip.2020.11.020] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 10/30/2020] [Accepted: 11/08/2020] [Indexed: 02/07/2023]
Abstract
Background Bronchial asthma has not been adequately assessed in coronavirus disease 2019 (COVID-19). Respiratory allergy is associated with significant reductions in the expression of angiotensin-converting enzyme 2 receptor, which is the entry receptor for COVID-19. Objective To observe COVID-19 susceptibility in patients with bronchial asthma, analyze the prevalence of asthma in a large cohort of consecutive outpatient subjects who were tested with the RT-PCR assay for COVID-19. Methods This was a retrospective population-based cross-sectional study using data from a large nationwide health maintenance organization in Israel. All health maintenance organization enrollees who had been tested for COVID-19 from February to June 2020 were included. Differences in demographic and clinical characteristics between the subjects with negative and positive COVID-19 RT-PCR test results and between COVID-19 RT-PCR–positive subjects with and without asthma were analyzed. Results A total of 37,469 subjects were tested for COVID-19 RT-PCR, and results for 2,266 (6.05%) of them were positive. A significantly higher proportion of smokers was observed in the COVID-19–negative group than in the COVID-19–positive group (4734 [13.45%] vs 103 [4.55%]; P < .001). Asthma was found in 153 (6.75 %) subjects of the COVID-19–positive group and in 3388 (9.62%) subjects of the COVID-19–negative group (P < .001). No significant impact of antileukotrienes, inhaled corticosteroids, and long-acting beta-blockers use was revealed on COVID-19 positivity proportions. Multiple logistic regression analysis adjusted for sex, age, smoking, and comorbidity revealed a negative association of asthma with the likelihood of being positive for COVID-19 (odds ratio, 0.71; 95% CI, 0.58-0.87; P = .001). Conclusions We observed lower COVID-19 susceptibility in patients with preexisting asthma.
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Hamood R, Hamood H, Merhasin I, Keinan-Boker L. Work Transitions in Breast Cancer Survivors and Effects on Quality of Life. JOURNAL OF OCCUPATIONAL REHABILITATION 2019; 29:336-349. [PMID: 29948472 DOI: 10.1007/s10926-018-9789-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Purpose Work transitions among breast cancer survivors remain an underexplored area. We aimed to examine prevalence and determinants of changes in work status, and the effect of these changes on quality of life of breast cancer survivors. Methods A cross-sectional study of 410 female breast cancer survivors randomly drawn from a larger study sample pool (n = 2644), members of "Leumit" healthcare fund, who were diagnosed with primary nonmetastatic invasive breast cancer in the years 2002-2012. The study questionnaire included questions on work characteristics and health-related quality-of-life and was completed by all women contacted. Work transition was defined as a downgrade (from full-time to part-time), termination, or retirement, and was contrasted to no change in work status (retention of full-time or part-time). Work transition was assessed at two intervals: between breast cancer diagnosis and treatment, and between breast cancer diagnosis and time of the survey. Results A total of 206 breast cancer survivors (50%) were employed prior to their diagnosis, of whom 12% stopped working, and 79% downgraded to part-time during treatment. At the time of survey (mean 8 ± 3 years post-diagnosis), 33% of those employed prior to their diagnosis stopped working or retired, 48% downgraded to part-time, and 19% had no change in their work situation. Work transition between diagnosis and time of the survey was significantly associated with poorer quality-of-life. In multivariable analyses, work transition between diagnosis and time of the survey was positively associated with being immigrant compared to native-born Israeli (odds ratio (OR) 4.65; 95% confidence interval (CI) 1.91-11.37; P = .001), and inversely with education level of college or over compared to high school or less (OR 0.27; 95% CI 0.09-0.86; P = .026). Conclusions Breast cancer survivors with characteristics pointing at underprivileged social circumstances more often experienced changes in work status after surviving breast cancer, irrespective of diagnosis, comorbidity or treatment. Breast cancer patients with immigrant status and/or lower educational attainment need more support to be able to keep their job.
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Affiliation(s)
- Rola Hamood
- School of Public Health, University of Haifa, Haifa, Israel
| | - Hatem Hamood
- School of Public Health, University of Haifa, Haifa, Israel.
- Leumit Health Services, Haharoshet 13, Karmiel, Israel.
| | | | - Lital Keinan-Boker
- School of Public Health, University of Haifa, Haifa, Israel
- Ministry of Health, Israel Center for Disease Control, Ramat Gan, Israel
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12
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Risk of cardiovascular disease after radiotherapy in survivors of breast cancer: A case-cohort study. J Cardiol 2019; 73:280-291. [DOI: 10.1016/j.jjcc.2018.10.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 09/27/2018] [Accepted: 10/13/2018] [Indexed: 12/27/2022]
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13
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Ho PJ, Tan CS, Shawon SR, Eriksson M, Lim LY, Miao H, Png E, Chia KS, Hartman M, Ludvigsson JF, Czene K, Hall P, Li J. Comparison of self-reported and register-based hospital medical data on comorbidities in women. Sci Rep 2019; 9:3527. [PMID: 30837593 PMCID: PMC6400937 DOI: 10.1038/s41598-019-40072-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 01/31/2019] [Indexed: 12/13/2022] Open
Abstract
Breast cancer patients commonly present with comorbidities which are known to influence treatment decisions and survival. We aim to examine agreement between self-reported and register-based medical records (National Patient Register [NPR]). Ascertainment of nine conditions, using individually-linked data from 64,961 women enrolled in the Swedish KARolinska MAmmography Project for Risk Prediction of Breast Cancer (KARMA) study. Agreement was assessed using observed proportion of agreement (overall agreement), expected proportion of agreement, and Cohen’s Kappa statistic. Two-stage logistic regression models taking into account chance agreement were used to identify potential predictors of overall agreement. High levels of overall agreement (i.e. ≥86.6%) were observed for all conditions. Substantial agreement (Cohen’s Kappa) was observed for myocardial infarction (0.74), diabetes (0.71) and stroke (0.64) between self-reported and NPR data. Moderate agreement was observed for preeclampsia (0.51) and hypertension (0.46). Fair agreement was observed for heart failure (0.40) and polycystic ovaries or ovarian cysts (0.27). For hyperlipidemia (0.14) and angina (0.10), slight agreement was observed. In most subgroups we observed negative specific agreement of >90%. There is no clear reference data source for ascertainment of conditions. Negative specific agreement between NPR and self-reported data is consistently high across all conditions.
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Affiliation(s)
- Peh Joo Ho
- Genome Institute of Singapore, 60 Biopolis Street, Genome, #02-01, Singapore, 138672, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Chuen Seng Tan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Shajedur Rahman Shawon
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Old road campus, OX3 7LF, Oxford, UK
| | - Mikael Eriksson
- Karolinska Institutet, Department of Medical Epidemiology and Biostatistics, Box 281, 171 77, Stockholm, Sweden
| | - Li Yan Lim
- Department of Surgery, University Surgical Cluster, National University Hospital, Singapore, Singapore
| | - Hui Miao
- Genome Institute of Singapore, 60 Biopolis Street, Genome, #02-01, Singapore, 138672, Singapore
| | - Eileen Png
- Genome Institute of Singapore, 60 Biopolis Street, Genome, #02-01, Singapore, 138672, Singapore
| | - Kee Seng Chia
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Mikael Hartman
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore.,Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jonas F Ludvigsson
- Karolinska Institutet, Department of Medical Epidemiology and Biostatistics, Box 281, 171 77, Stockholm, Sweden.,Department of Pediatrics, Örebro University Hospital, Örebro University, Örebro, Sweden
| | - Kamila Czene
- Karolinska Institutet, Department of Medical Epidemiology and Biostatistics, Box 281, 171 77, Stockholm, Sweden
| | - Per Hall
- Karolinska Institutet, Department of Medical Epidemiology and Biostatistics, Box 281, 171 77, Stockholm, Sweden.,Department of Oncology, Södersjukhuset, 118 84, Stockholm, Sweden
| | - Jingmei Li
- Genome Institute of Singapore, 60 Biopolis Street, Genome, #02-01, Singapore, 138672, Singapore. .,Karolinska Institutet, Department of Medical Epidemiology and Biostatistics, Box 281, 171 77, Stockholm, Sweden. .,Department of Surgery, University Surgical Cluster, National University Hospital, Singapore, Singapore.
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14
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Hamood R, Hamood H, Merhasin I, Keinan-Boker L. Hormone therapy and osteoporosis in breast cancer survivors: assessment of risk and adherence to screening recommendations. Osteoporos Int 2019; 30:187-200. [PMID: 30413856 DOI: 10.1007/s00198-018-4758-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 10/30/2018] [Indexed: 02/07/2023]
Abstract
UNLABELLED The long-term impact of hormone therapy for breast cancer on risk of osteoporosis and the extent to which bone screening recommendations are implemented in daily practice remain unknown. We found that the aromatase inhibitor-induced risk of osteoporosis did not continue in the off-treatment follow-up. Adherence to screening recommendations was suboptimal. INTRODUCTION A case-cohort study was undertaken to better understand the impact of hormone therapy on breast cancer patients' risk of osteoporosis, and to estimate the extent to which current bone mineral density screening recommendations are implemented in real-life daily practice. METHODS This study is based on 1692 female breast cancer survivors recruited from "Leumit" healthcare fund, who were diagnosed with primary nonmetastatic invasive breast cancer between 2002 and 2012. A 20% random subcohort was sampled at baseline, and all osteoporosis cases were identified. Adjusted hazard ratios (HR) with 95% confidence intervals (CI) were estimated by weighted Cox proportional hazards models. RESULTS Of 1692 breast cancer survivors, 312 developed osteoporosis during a median follow-up of 5 years. The crude cumulative incidence of osteoporosis accounting for death as a competing risk was 25.7% (95% CI, 21.9-29.5%). In multivariable analyses, osteoporosis was positively associated with the aromatase inhibitor (AI) sequential treatment after tamoxifen (HR, 3.14; 95% CI, 1.44-6.88; P = .004) but was more pronounced with AI use as upfront monotherapy (HR, 5.53; 95% CI, 1.46-20.88; P = .012). This effect did not continue in the off-treatment follow-up. In subgroup analysis by menopausal status, tamoxifen did not seem to confer a protective effect on bone health in postmenopausal patients. Adherence to screening recommendations in AI-treated postmenopausal women was suboptimal, particularly at baseline and after 48 months of continuous AI use. CONCLUSIONS The natural, age-related reduction in bone density is exacerbated by breast cancer active AI treatment. Future research should focus on investigating screening adherence-related barriers/facilitators and effective strategies to bring practice in line with agreed standards.
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Affiliation(s)
- R Hamood
- School of Public Health, University of Haifa, Haifa, Israel
| | - H Hamood
- School of Public Health, University of Haifa, Haifa, Israel.
- Leumit Health Services, Haharoshet 13, Karmiel, Israel.
| | | | - L Keinan-Boker
- School of Public Health, University of Haifa, Haifa, Israel
- Ministry of Health, Israel Center for Disease Control, Ramat Gan, Israel
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15
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Cleophat JE, Nabi H, Pelletier S, Bouchard K, Dorval M. What characterizes cancer family history collection tools? A critical literature review. ACTA ACUST UNITED AC 2018; 25:e335-e350. [PMID: 30111980 DOI: 10.3747/co.25.4042] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background Many tools have been developed for the standardized collection of cancer family history (fh). However, it remains unclear which tools have the potential to help health professionals overcome traditional barriers to collecting such histories. In this review, we describe the characteristics, validation process, and performance of existing tools and appraise the extent to which those tools can support health professionals in identifying and managing at-risk individuals. Methods Studies were identified through searches of the medline, embase, and Cochrane central databases from October 2015 to September 2016. Articles were included if they described a cancer fh collection tool, its use, and its validation process. Results Based on seventy-nine articles published between February 1978 and September 2016, 62 tools were identified. Most of the tools were paper-based and designed to be self-administered by lay individuals. One quarter of the tools could automatically produce pedigrees, provide cancer-risk assessment, and deliver evidence-based recommendations. One third of the tools were validated against a standard reference for collected fh quality and cancer-risk assessment. Only 3 tools were integrated into an electronic health records system. Conclusions In the present review, we found no tool with characteristics that might make it an efficient clinical support for health care providers in cancer-risk identification and management. Adequately validated tools that are connected to electronic health records are needed to encourage the systematic identification of individuals at increased risk of cancer.
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Affiliation(s)
- J E Cleophat
- Centre de recherche du chu de Québec, Axe Oncologie, Quebec City, QC.,Université Laval, Faculté de pharmacie, Quebec City, QC.,Centre de recherche sur le cancer, Quebec City, QC
| | - H Nabi
- Centre de recherche du chu de Québec, Axe Oncologie, Quebec City, QC.,Centre de recherche sur le cancer, Quebec City, QC.,inserm, U1018, Centre de recherche en épidémiologie et santé des populations, Villejuif, France
| | - S Pelletier
- Centre de recherche du chu de Québec, Axe Oncologie, Quebec City, QC.,Centre de recherche sur le cancer, Quebec City, QC
| | - K Bouchard
- Centre de recherche du chu de Québec, Axe Oncologie, Quebec City, QC.,Centre de recherche sur le cancer, Quebec City, QC
| | - M Dorval
- Centre de recherche du chu de Québec, Axe Oncologie, Quebec City, QC.,Université Laval, Faculté de pharmacie, Quebec City, QC.,Centre de recherche sur le cancer, Quebec City, QC.,Centre de recherche du cisss Chaudière-Appalaches, Lévis, QC
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16
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Hamood R, Hamood H, Merhasin I, Keinan-Boker L. Diabetes After Hormone Therapy in Breast Cancer Survivors: A Case-Cohort Study. J Clin Oncol 2018; 36:2061-2069. [PMID: 29688833 DOI: 10.1200/jco.2017.76.3524] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Purpose Breast cancer treatments have been associated with an increased risk of multiple health-related adverse outcomes, but the relationship with diabetes remains unclear. This study investigated the association between hormone therapy and diabetes risk in breast cancer survivors. Patients and Methods We performed a case-cohort study of 2,246 female survivors recruited from the Leumit health care fund who were diagnosed with primary nonmetastatic invasive breast cancer in 2002 through 2012. A 20% random subcohort was sampled at baseline, and all diabetes cases were identified. Adjusted hazard ratios (HRs) with 95% CIs were estimated by weighted Cox proportional hazards regression models. Results Of 2,246 breast cancer survivors, 324 developed diabetes over a mean follow-up of 5.9 years. The crude cumulative incidence of diabetes that accounted for death as a competing risk was 20.9% (95% CI, 18.3% to 23.7%). In multivariable-adjusted models, hormone therapy was associated with increased diabetes risk (HR, 2.40; 95% CI, 1.26 to 4.55; P = .008). The hazard for tamoxifen use (HR, 2.25; 95% CI, 1.19 to 4.26; P = .013) was less pronounced than the use of aromatase inhibitors (HR, 4.27, 95% CI, 1.42 to 12.84; P = .010). Conclusion Active hormone therapy is a significant risk factor of diabetes among breast cancer survivors. Although cessation of treatment is not recommended because the survival benefits of hormone therapy outweigh the risks, preventive strategies aimed at lifestyle modifications may minimize the risk.
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Affiliation(s)
- Rola Hamood
- Rola Hamood and Lital Keinan-Boker, University of Haifa, Haifa; Hatem Hamood and Ilya Merhasin, Leumit Health Services, Netanya; and Lital Keinan-Boker, Israel Center for Disease Control, Ramat Gan, Israel
| | - Hatem Hamood
- Rola Hamood and Lital Keinan-Boker, University of Haifa, Haifa; Hatem Hamood and Ilya Merhasin, Leumit Health Services, Netanya; and Lital Keinan-Boker, Israel Center for Disease Control, Ramat Gan, Israel
| | - Ilya Merhasin
- Rola Hamood and Lital Keinan-Boker, University of Haifa, Haifa; Hatem Hamood and Ilya Merhasin, Leumit Health Services, Netanya; and Lital Keinan-Boker, Israel Center for Disease Control, Ramat Gan, Israel
| | - Lital Keinan-Boker
- Rola Hamood and Lital Keinan-Boker, University of Haifa, Haifa; Hatem Hamood and Ilya Merhasin, Leumit Health Services, Netanya; and Lital Keinan-Boker, Israel Center for Disease Control, Ramat Gan, Israel
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17
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Agreement between clinician-rated versus patient-reported outcomes in Huntington disease. J Neurol 2018; 265:1443-1453. [PMID: 29687215 DOI: 10.1007/s00415-018-8852-5] [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: 11/20/2017] [Revised: 03/27/2018] [Accepted: 03/29/2018] [Indexed: 01/24/2023]
Abstract
BACKGROUND Clinician-rated measures of functioning are often used as primary endpoints in clinical trials and other behavioral research in Huntington disease. As study costs for clinician-rated assessments are not always feasible, there is a question of whether patient self-report of commonly used clinician-rated measures may serve as acceptable alternatives in low risk behavioral trials. AIM The purpose of this paper was to determine the level of agreement between self-report and clinician-ratings of commonly used functional assessment measures in Huntington disease. DESIGN 486 participants with premanifest or manifest Huntington disease were examined. Total Functional Capacity, Functional Assessment, and Independence Scale assessments from the Unified Huntington Disease Rating scale were completed by clinicians; a self-report version was also completed by individuals with Huntington disease. Cronbach's α was used to examine internal consistency, one-way analysis of variance was used to examine group differences, and paired t tests, kappa agreement coefficients, and intra-class correlations were calculated to determine agreement between raters. RESULTS Internal consistency for self-reported ratings of functional capacity and ability were good. There were significant differences between those with premanifest, early-, and late-stage disease; those with later-stage disease reported less ability and independence than the other clinical groups. Although self-report ratings were not a perfect match with associated clinician-rated measures, differences were small. Cutoffs for achieving specified levels of agreement are provided. CONCLUSIONS Depending on the acceptable margin of error in a study, self-reported administration of these functional assessments may be appropriate when clinician-related assessments are not feasible.
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18
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Chronic pain and other symptoms among breast cancer survivors: prevalence, predictors, and effects on quality of life. Breast Cancer Res Treat 2017; 167:157-169. [DOI: 10.1007/s10549-017-4485-0] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 08/23/2017] [Indexed: 10/19/2022]
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19
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Dorland HF, Abma FI, Roelen CAM, Stewart RE, Amick BC, Ranchor AV, Bültmann U. Work functioning trajectories in cancer patients: Results from the longitudinal Work Life after Cancer (WOLICA) study. Int J Cancer 2017; 141:1751-1762. [PMID: 28681478 DOI: 10.1002/ijc.30876] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 05/19/2017] [Accepted: 06/16/2017] [Indexed: 11/12/2022]
Abstract
More than 60% of cancer patients are able to work after cancer diagnosis. However, little is known about their functioning at work. Therefore, the aims of this study were to (1) identify work functioning trajectories in the year following return to work (RTW) in cancer patients and (2) examine baseline sociodemographic, health-related and work-related variables associated with work functioning trajectories. This longitudinal cohort study included 384 cancer patients who have returned to work after cancer diagnosis. Work functioning was measured at baseline, 3, 6, 9 and 12 months follow-up. Latent class growth modeling (LCGM) was used to identify work functioning trajectories. Associations of baseline variables with work functioning trajectories were examined using univariate and multivariate analyses. LCGM analyses with cancer patients who completed on at least three time points the Work Role Functioning Questionnaire (n = 324) identified three work functioning trajectories: "persistently high" (16% of the sample), "moderate to high" (54%) and "persistently low" work functioning (32%). Cancer patients with persistently high work functioning had less time between diagnosis and RTW and had less often a changed meaning of work, while cancer patients with persistently low work functioning reported more baseline cognitive symptoms compared to cancer patients in the other trajectories. This knowledge has implications for cancer care and guidance of cancer patients at work.
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Affiliation(s)
- Heleen F Dorland
- Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Femke I Abma
- Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Corné A M Roelen
- Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.,HumanCapitalCare, Enschede, the Netherlands
| | - Roy E Stewart
- Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Benjamin C Amick
- Department of Health Policy and Management, Florida International University, Robert Stempel College of Public Health & Social Work, Miami, Florida.,Institute for Work & Health, Toronto, Canada
| | - Adelita V Ranchor
- Department of Health Psychology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Ute Bültmann
- Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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Rein A, Simpson LA. Finding "truth" across different data sources. Isr J Health Policy Res 2017; 6:14. [PMID: 28344767 PMCID: PMC5360036 DOI: 10.1186/s13584-017-0138-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 03/10/2017] [Indexed: 12/03/2022] Open
Abstract
The proliferation of new technology platforms and tools is dramatically advancing our ability to capture, integrate and use clinical and other health related data for research and care. Another critical and increasingly common source of data comes directly from patients – often in the form of Patient Reported Outcomes (PRO). As more providers and payers recognize that patient experiences reflect a critical dimension of the value proposition, these data are informing broader strategies to achieve performance improvement and accountability in health systems. Combined with other traditional (e.g., claims) and more recent (e.g., Electronic Health Record) data assets, PROs can help to examine experiences and outcomes that convey a more complete picture of both individual and population health. One of the areas of research where this is most evident is cancer survivorship, including long-term adverse effects, as the population of survivors is increasing given advances in detection and treatment. Key questions remain as to how and under what conditions these new data resources can be used for research, and which are the best “sources of truth” for specific types of information. A recent IJHPR validation study by Hamood et al. reflects important progress in this regard, and establishes the necessary groundwork for a larger planned study. There are some important limitations worth noting, such as a small sample size (which does not support adequate subgroup analysis); a relatively narrow focus on women with only early stage or regionally advanced breast cancer; and a limited focus on outcomes that are primarily clinical and relatively severe in nature (e.g., cardiovascular disease). Finally, as use of EHRs becomes ubiquitous, as patient perspectives and outcome measures are considered, and as more types of data are systematically collected via electronic systems, further comparison and validation of non-clinical data elements captured via such tools will become increasingly possible and important. This will further enhance the capacity of cancer survivorship researchers to address a broader range of important questions to many more types of patients.
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Affiliation(s)
- Alison Rein
- AcademyHealth, 1666K Street, Suite 1100, Washington, DC, 20006 USA
| | - Lisa A Simpson
- AcademyHealth, 1666K Street, Suite 1100, Washington, DC, 20006 USA
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