1
|
Gercek O, Ulusoy K, Yazar VM, Topal K. Effects of delayed diagnosis on tumor size, stage and grade in bladder cancer. Int Urol Nephrol 2024; 56:935-940. [PMID: 37847325 DOI: 10.1007/s11255-023-03829-1] [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: 09/11/2023] [Accepted: 09/29/2023] [Indexed: 10/18/2023]
Abstract
OBJECTIVE This study is planned based on the hypothesis that if bladder cancer is detected early, the disease would be less advanced and the possibility of treatment will increase, at least the recurrence-free survival will be longer. Regarding this hypothesis, it is aimed to investigate the effect of delayed diagnosis primarily on the disease factors. MATERIALS AND METHODS The study included 169 patients, who underwent TUR-BT with the suspicion of bladder cancer in the urology clinic of Afyonkarahisar Faculty of Medicine between April 2018 and April 2023. Demographic and clinical data of the patients were recorded and compared. RESULTS It was observed that the delay in diagnosis was significantly longer in patients with tumors larger than 3 cm compared to patients with tumors smaller than 3 cm (p < 0.001). In the correlation analysis between tumor size, duration of diagnosis delay, age, T stage, and tumor grade, a low level of positive correlation was observed between tumor size and duration of diagnosis delay, and it was statistically significant (r = 0.215, p = 0.005). CONCLUSION In our study, it was shown that the tumor size increases as the duration of diagnosis delay increases and this increase causes an increase of 0.088 mm in the pathological size of the tumor in the 1-day delay period. Considering that tumor size changes the risk group of the disease in bladder tumors, and relatedly the follow-up and treatment process changes, we believe that these data will be valuable in the management of bladder cancer.
Collapse
Affiliation(s)
- O Gercek
- Department of Urology, Afyonkarahisar Health Sciences University, 03100, Afyonkarahisar, Turkey.
| | - K Ulusoy
- Department of Urology, Afyonkarahisar Health Sciences University, 03100, Afyonkarahisar, Turkey
| | - V M Yazar
- Department of Urology, Afyonkarahisar Health Sciences University, 03100, Afyonkarahisar, Turkey
| | - K Topal
- Department of Urology, Afyonkarahisar State Hospital, Afyonkarahisar, Turkey
| |
Collapse
|
2
|
Altowaijri K, Aldehaim M, Alshammari O, Aldohan R, AlTabbaa F, Kazi A. A Survey on the Knowledge and Awareness of Testicular Cancer and Testicular Self-Examination Among Men in Saudi Arabia. Cureus 2024; 16:e55778. [PMID: 38586720 PMCID: PMC10999108 DOI: 10.7759/cureus.55778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2024] [Indexed: 04/09/2024] Open
Abstract
Objectives The aim of the study was to assess the knowledge and awareness of testicular cancer (TC) and testicular self-examination (TSE) and to identify the associated factors in men in Saudi Arabia. Methods An online questionnaire-based study was conducted in Saudi Arabia with a representative sample of 794 participants. The questionnaire comprised knowledge, awareness and attitude questions regarding TC and TSE in addition to signs/symptoms and risk factors. Multivariate logistic regression analysis was conducted to identify the significant variables associated with knowledge of TC and TSE. Results Around 43% (n=340) of the participants had inadequate knowledge of TC, whereas 26% (n=205) had heard about TSE and only 65 (8.2%) performed TSE. The first model for knowledge found that participants with a low level of education [2.75 (1.18, 6.42)]; no past history of a testicular problem [2.20 (1.22, 3.95)] and those who had not heard about TSE [1.79 (1.24, 2.57)] were at higher odds for inadequate knowledge, whereas those whose mothers had received college-level education [0.39 (0.19, 0.79)] and those who received information from school/college [0.61 (0.37, 0.97)] were more likely to have adequate knowledge about TC. The second model for TSE found that a low level of education 5.24 (1.34, 20.52) was associated with not performing TSE. Receiving information from social media [0.08 (0.03, 0.17)], school/college [0.06 (0.02, 0.13)], family and friends [0.17 (0.05, 0.57)] and medical staff [0.08 (0.03, 0.17)] were associated with higher odds of performing TSE. Conclusion The majority of Saudi males have knowledge about TC. On the contrary, only a small percentage of the respondents have heard of or performed TSE as a screening technique. Educated sources of information can be a reliable way of giving correct knowledge on sensitive topics like TSE.
Collapse
Affiliation(s)
| | | | | | - Rakan Aldohan
- College of Medicine, King Saud University, Riyadh, SAU
| | | | - Ambreen Kazi
- Family and Community Medicine, King Saud University Medical City, Riyadh, SAU
| |
Collapse
|
3
|
Kerekes DM, Frey AE, Bakkila BF, Johnson CH, Becher RD, Billingsley KG, Khan SA. Hepatopancreatobiliary malignancies: time to treatment matters. J Gastrointest Oncol 2023; 14:833-848. [PMID: 37201090 PMCID: PMC10186552 DOI: 10.21037/jgo-22-1067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 03/21/2023] [Indexed: 05/20/2023] Open
Abstract
Background Initiation of oncologic care is often delayed, yet little is known about delays in hepatopancreatobiliary (HPB) cancers or their impact. This retrospective cohort study describes trends in time to treatment initiation (TTI), assesses the association between TTI and survival, and identifies predictors of TTI in HPB cancers. Methods The National Cancer Database was queried for patients with cancers of the pancreas, liver, and bile ducts between 2004 and 2017. Kaplan-Meier survival analysis and Cox regression were used to investigate the association between TTI and overall survival for each cancer type and stage. Multivariable regression identified factors associated with longer TTI. Results Of 318,931 patients with HPB cancers, median TTI was 31 days. Longer TTI was associated with increased mortality in patients with stages I-III extrahepatic bile duct (EHBD) cancer and stages I-II pancreatic adenocarcinoma. Patients treated within 3-30, 31-60, and 61-90 days had median survivals of 51.5, 34.9, and 25.4 months (log-rank P<0.001), respectively, for stage I EHBD cancer, and 18.8, 16.6, and 15.2 months for stage I pancreatic cancer, respectively (P<0.001). Factors associated with increased TTI included stage I disease (+13.7 days vs. stage IV, P<0.001), treatment with radiation only (β=+13.9 days, P<0.001), Black race (+4.6 days, P<0.001) and Hispanic ethnicity (+4.3 days, P<0.001). Conclusions Some HPB cancer patients with longer time to definitive care experienced higher mortality than patients treated expeditiously, particularly in non-metastatic EHBD cancer. Black and Hispanic patients are at risk for delayed treatment. Further research into these associations is needed.
Collapse
Affiliation(s)
| | | | | | - Caroline H. Johnson
- Department of Environmental Health Sciences, Yale School of Public Health, Yale University, New Haven, CT, USA
| | - Robert D. Becher
- Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | | | - Sajid A. Khan
- Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| |
Collapse
|
4
|
Cieślikowski WA, Kasperczak M, Milecki T, Antczak A. Reasons behind the Delayed Diagnosis of Testicular Cancer: A Retrospective Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4752. [PMID: 36981661 PMCID: PMC10049095 DOI: 10.3390/ijerph20064752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 02/27/2023] [Accepted: 03/02/2023] [Indexed: 06/18/2023]
Abstract
The aim of the present study was to identify the reasons behind the delayed diagnosis of testicular cancer in a group of Polish males diagnosed with this malignancy in 2015-2016. The study included data from 72 patients aged between 18 and 69 years. Based on the median time elapsed to the testicular cancer diagnosis, the study patients were divided into the timely diagnosis group (diagnosis within 10 weeks from initial manifestation, n = 40) and the delayed diagnosis group (diagnosis > 10 weeks from initial manifestation, n = 32). Diagnosis of testicular cancer > 10 weeks after its initial manifestation was associated with less favorable survival (5-year overall survival: 78.1% [95% CI: 59.5-88.9%] vs. 92.5% [95% CI: 78.5-97.5%], p = 0.087). Multivariate logistic regression analysis identified two independent predictors of the delayed diagnosis, age > 33 years (OR = 6.65, p = 0.020) and residence in the countryside (OR = 7.21, p = 0.012), with another two parameters, the lack of a regular intimate partner (OR = 3.32, p = 0.098) and the feeling of shame (OR = 8.13, p = 0.056), being at the verge of statistical significance. All the factors mentioned above should be considered during planning social campaigns aimed at the early detection of testicular malignancies, along with improving the quality and trustfulness of Internet-based information resources.
Collapse
|
5
|
Aboelkhir HAB, Elomri A, ElMekkawy TY, Kerbache L, Elakkad MS, Al-Ansari A, Aboumarzouk OM, El Omri A. A Bibliometric Analysis and Visualization of Decision Support Systems for Healthcare Referral Strategies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16952. [PMID: 36554837 PMCID: PMC9778793 DOI: 10.3390/ijerph192416952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 10/24/2022] [Accepted: 11/14/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND The referral process is an important research focus because of the potential consequences of delays, especially for patients with serious medical conditions that need immediate care, such as those with metastatic cancer. Thus, a systematic literature review of recent and influential manuscripts is critical to understanding the current methods and future directions in order to improve the referral process. METHODS A hybrid bibliometric-structured review was conducted using both quantitative and qualitative methodologies. Searches were conducted of three databases, Web of Science, Scopus, and PubMed, in addition to the references from the eligible papers. The papers were considered to be eligible if they were relevant English articles or reviews that were published from January 2010 to June 2021. The searches were conducted using three groups of keywords, and bibliometric analysis was performed, followed by content analysis. RESULTS A total of 163 papers that were published in impactful journals between January 2010 and June 2021 were selected. These papers were then reviewed, analyzed, and categorized as follows: descriptive analysis (n = 77), cause and effect (n = 12), interventions (n = 50), and quality management (n = 24). Six future research directions were identified. CONCLUSIONS Minimal attention was given to the study of the primary referral of blood cancer cases versus those with solid cancer types, which is a gap that future studies should address. More research is needed in order to optimize the referral process, specifically for suspected hematological cancer patients.
Collapse
Affiliation(s)
| | - Adel Elomri
- College of Science and Engineering, Hamad Bin Khalifa University, Doha 34110, Qatar
| | - Tarek Y. ElMekkawy
- Department of Mechanical and Industrial Engineering, College of Engineering, Qatar University, Doha 2713, Qatar
| | - Laoucine Kerbache
- College of Science and Engineering, Hamad Bin Khalifa University, Doha 34110, Qatar
| | - Mohamed S. Elakkad
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation, Doha 3050, Qatar
| | - Abdulla Al-Ansari
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation, Doha 3050, Qatar
| | - Omar M. Aboumarzouk
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation, Doha 3050, Qatar
- College of Medicine, QU-Health, Qatar University, Doha 2713, Qatar
- School of Medicine, Dentistry and Nursing, The University of Glasgow, Glasgow G12 8QQ, UK
| | - Abdelfatteh El Omri
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation, Doha 3050, Qatar
| |
Collapse
|
6
|
Lee-Ying R, O'Sullivan DE, Gagnon R, Bosma N, Stewart RN, Railton C, Tilley D, Alimohamed N, Basappa N, Cheng T, Kolinsky M, Karim S, Ruether D, North S, Yip S, Danielson B, Heng D, Brenner D. Stage migration of testicular germ cell tumours in Alberta, Canada, during the COVID-19 pandemic: a retrospective cohort study. CMAJ Open 2022; 10:E633-E642. [PMID: 35790231 PMCID: PMC9262347 DOI: 10.9778/cmajo.20210285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND An absence of screening recommendations and the rapid progression of testicular germ cell tumours (TGCTs) offer a perspective on the potential impact of the COVID-19 pandemic on cancer presentations. We evaluated the presenting cancer stages of TGCTs in a real-world population before and during the pandemic to assess stage migration. METHODS We performed a retrospective review of all new patients with TGCT diagnoses in Alberta, Canada, from Dec. 31, 2018, to Apr. 30, 2021, using the Alberta Cancer Registry. Because potential changes in staging should not occur instantaneously, we used a 6-month lag time from Apr. 1, 2020, for seminomas, and a 3-month lag time for nonseminomas, to compare initial cancer stages at presentation before and during the pandemic. We evaluated monthly rates of presentation by stage and histology. Exploratory outcomes included the largest tumour dimension, tumour markers and, for advanced disease, risk category and treatment setting. RESULTS Of 335 patients with TGCTs, 231 were diagnosed before the pandemic and 104 during the pandemic (using a lag time). In total, 18 (7.8%) patients diagnosed before the pandemic presented with stage III disease, compared to 16 (15.4%) diagnosed during the pandemic (relative risk 1.97, 95% confidence interval [CI] 1.05-3.72). We observed no significant differences for secondary outcomes. Without a lag time, the rate ratio for a stage II presentation decreased significantly during the pandemic (0.40, 95% CI 0.21-0.72). INTERPRETATION We observed signs of TGCT stage migration during the COVID-19 pandemic, driven by a decline in stage II disease and a potential rise in stage III disease. Management of TGCTs should remain a priority, even during a global pandemic.
Collapse
Affiliation(s)
- Richard Lee-Ying
- Department of Oncology (Lee-Ying, O'Sullivan, Gagnon, Stewart, Railton, Tilley, Alimohamed, Cheng, Karim, Ruether, Yip, Heng, Brenner), University of Calgary, Tom Baker Cancer Centre, Calgary, Alta.; BC Cancer Agency-Victoria (Bosma), Victoria, BC; Department of Oncology (Basappa, Kolinsky, North, Danielson), University of Alberta, Cross Cancer Institute, Edmonton, Alta
| | - Dylan E O'Sullivan
- Department of Oncology (Lee-Ying, O'Sullivan, Gagnon, Stewart, Railton, Tilley, Alimohamed, Cheng, Karim, Ruether, Yip, Heng, Brenner), University of Calgary, Tom Baker Cancer Centre, Calgary, Alta.; BC Cancer Agency-Victoria (Bosma), Victoria, BC; Department of Oncology (Basappa, Kolinsky, North, Danielson), University of Alberta, Cross Cancer Institute, Edmonton, Alta
| | - Richard Gagnon
- Department of Oncology (Lee-Ying, O'Sullivan, Gagnon, Stewart, Railton, Tilley, Alimohamed, Cheng, Karim, Ruether, Yip, Heng, Brenner), University of Calgary, Tom Baker Cancer Centre, Calgary, Alta.; BC Cancer Agency-Victoria (Bosma), Victoria, BC; Department of Oncology (Basappa, Kolinsky, North, Danielson), University of Alberta, Cross Cancer Institute, Edmonton, Alta.
| | - Nicholas Bosma
- Department of Oncology (Lee-Ying, O'Sullivan, Gagnon, Stewart, Railton, Tilley, Alimohamed, Cheng, Karim, Ruether, Yip, Heng, Brenner), University of Calgary, Tom Baker Cancer Centre, Calgary, Alta.; BC Cancer Agency-Victoria (Bosma), Victoria, BC; Department of Oncology (Basappa, Kolinsky, North, Danielson), University of Alberta, Cross Cancer Institute, Edmonton, Alta
| | - Rebecca N Stewart
- Department of Oncology (Lee-Ying, O'Sullivan, Gagnon, Stewart, Railton, Tilley, Alimohamed, Cheng, Karim, Ruether, Yip, Heng, Brenner), University of Calgary, Tom Baker Cancer Centre, Calgary, Alta.; BC Cancer Agency-Victoria (Bosma), Victoria, BC; Department of Oncology (Basappa, Kolinsky, North, Danielson), University of Alberta, Cross Cancer Institute, Edmonton, Alta
| | - Cindy Railton
- Department of Oncology (Lee-Ying, O'Sullivan, Gagnon, Stewart, Railton, Tilley, Alimohamed, Cheng, Karim, Ruether, Yip, Heng, Brenner), University of Calgary, Tom Baker Cancer Centre, Calgary, Alta.; BC Cancer Agency-Victoria (Bosma), Victoria, BC; Department of Oncology (Basappa, Kolinsky, North, Danielson), University of Alberta, Cross Cancer Institute, Edmonton, Alta
| | - Derek Tilley
- Department of Oncology (Lee-Ying, O'Sullivan, Gagnon, Stewart, Railton, Tilley, Alimohamed, Cheng, Karim, Ruether, Yip, Heng, Brenner), University of Calgary, Tom Baker Cancer Centre, Calgary, Alta.; BC Cancer Agency-Victoria (Bosma), Victoria, BC; Department of Oncology (Basappa, Kolinsky, North, Danielson), University of Alberta, Cross Cancer Institute, Edmonton, Alta
| | - Nimira Alimohamed
- Department of Oncology (Lee-Ying, O'Sullivan, Gagnon, Stewart, Railton, Tilley, Alimohamed, Cheng, Karim, Ruether, Yip, Heng, Brenner), University of Calgary, Tom Baker Cancer Centre, Calgary, Alta.; BC Cancer Agency-Victoria (Bosma), Victoria, BC; Department of Oncology (Basappa, Kolinsky, North, Danielson), University of Alberta, Cross Cancer Institute, Edmonton, Alta
| | - Naveen Basappa
- Department of Oncology (Lee-Ying, O'Sullivan, Gagnon, Stewart, Railton, Tilley, Alimohamed, Cheng, Karim, Ruether, Yip, Heng, Brenner), University of Calgary, Tom Baker Cancer Centre, Calgary, Alta.; BC Cancer Agency-Victoria (Bosma), Victoria, BC; Department of Oncology (Basappa, Kolinsky, North, Danielson), University of Alberta, Cross Cancer Institute, Edmonton, Alta
| | - Tina Cheng
- Department of Oncology (Lee-Ying, O'Sullivan, Gagnon, Stewart, Railton, Tilley, Alimohamed, Cheng, Karim, Ruether, Yip, Heng, Brenner), University of Calgary, Tom Baker Cancer Centre, Calgary, Alta.; BC Cancer Agency-Victoria (Bosma), Victoria, BC; Department of Oncology (Basappa, Kolinsky, North, Danielson), University of Alberta, Cross Cancer Institute, Edmonton, Alta
| | - Michael Kolinsky
- Department of Oncology (Lee-Ying, O'Sullivan, Gagnon, Stewart, Railton, Tilley, Alimohamed, Cheng, Karim, Ruether, Yip, Heng, Brenner), University of Calgary, Tom Baker Cancer Centre, Calgary, Alta.; BC Cancer Agency-Victoria (Bosma), Victoria, BC; Department of Oncology (Basappa, Kolinsky, North, Danielson), University of Alberta, Cross Cancer Institute, Edmonton, Alta
| | - Safiya Karim
- Department of Oncology (Lee-Ying, O'Sullivan, Gagnon, Stewart, Railton, Tilley, Alimohamed, Cheng, Karim, Ruether, Yip, Heng, Brenner), University of Calgary, Tom Baker Cancer Centre, Calgary, Alta.; BC Cancer Agency-Victoria (Bosma), Victoria, BC; Department of Oncology (Basappa, Kolinsky, North, Danielson), University of Alberta, Cross Cancer Institute, Edmonton, Alta
| | - Dean Ruether
- Department of Oncology (Lee-Ying, O'Sullivan, Gagnon, Stewart, Railton, Tilley, Alimohamed, Cheng, Karim, Ruether, Yip, Heng, Brenner), University of Calgary, Tom Baker Cancer Centre, Calgary, Alta.; BC Cancer Agency-Victoria (Bosma), Victoria, BC; Department of Oncology (Basappa, Kolinsky, North, Danielson), University of Alberta, Cross Cancer Institute, Edmonton, Alta
| | - Scott North
- Department of Oncology (Lee-Ying, O'Sullivan, Gagnon, Stewart, Railton, Tilley, Alimohamed, Cheng, Karim, Ruether, Yip, Heng, Brenner), University of Calgary, Tom Baker Cancer Centre, Calgary, Alta.; BC Cancer Agency-Victoria (Bosma), Victoria, BC; Department of Oncology (Basappa, Kolinsky, North, Danielson), University of Alberta, Cross Cancer Institute, Edmonton, Alta
| | - Steven Yip
- Department of Oncology (Lee-Ying, O'Sullivan, Gagnon, Stewart, Railton, Tilley, Alimohamed, Cheng, Karim, Ruether, Yip, Heng, Brenner), University of Calgary, Tom Baker Cancer Centre, Calgary, Alta.; BC Cancer Agency-Victoria (Bosma), Victoria, BC; Department of Oncology (Basappa, Kolinsky, North, Danielson), University of Alberta, Cross Cancer Institute, Edmonton, Alta
| | - Brita Danielson
- Department of Oncology (Lee-Ying, O'Sullivan, Gagnon, Stewart, Railton, Tilley, Alimohamed, Cheng, Karim, Ruether, Yip, Heng, Brenner), University of Calgary, Tom Baker Cancer Centre, Calgary, Alta.; BC Cancer Agency-Victoria (Bosma), Victoria, BC; Department of Oncology (Basappa, Kolinsky, North, Danielson), University of Alberta, Cross Cancer Institute, Edmonton, Alta
| | - Daniel Heng
- Department of Oncology (Lee-Ying, O'Sullivan, Gagnon, Stewart, Railton, Tilley, Alimohamed, Cheng, Karim, Ruether, Yip, Heng, Brenner), University of Calgary, Tom Baker Cancer Centre, Calgary, Alta.; BC Cancer Agency-Victoria (Bosma), Victoria, BC; Department of Oncology (Basappa, Kolinsky, North, Danielson), University of Alberta, Cross Cancer Institute, Edmonton, Alta
| | - Darren Brenner
- Department of Oncology (Lee-Ying, O'Sullivan, Gagnon, Stewart, Railton, Tilley, Alimohamed, Cheng, Karim, Ruether, Yip, Heng, Brenner), University of Calgary, Tom Baker Cancer Centre, Calgary, Alta.; BC Cancer Agency-Victoria (Bosma), Victoria, BC; Department of Oncology (Basappa, Kolinsky, North, Danielson), University of Alberta, Cross Cancer Institute, Edmonton, Alta
| |
Collapse
|
7
|
Majewska K, Zawolik W, Targoński A, Tkocz M. A rare case of giant teratocarcinoma of the testis with accumulation of fluid. Urol Case Rep 2022; 43:102057. [PMID: 35342715 PMCID: PMC8943395 DOI: 10.1016/j.eucr.2022.102057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 03/06/2022] [Accepted: 03/16/2022] [Indexed: 11/30/2022] Open
Abstract
Testicular cancer is one of the most curable cancers. However, the course of the disease largely depends on the clinical stage at diagnosis, and there are still cases where the tumor size is large, which makes surgical treatment challenging. A 30-year-old man presented with painless, extremely enlarged scrotum. A CT scan revealed a tumor of the right testis of 21.5 × 15 × 18cm in size. The patient underwent a right orchiectomy and histologic examination revealed teratocarcinoma. Suspicion of hydrocele testis should prompt meticulous differential diagnosis including malignancies. There is a strong need to increase public awareness in terms of symptoms of testicular cancer. In the presence of a giant hydrocele, palpation of the testis might prove impossible. Suspicion of hydrocele testis should prompt meticulous differential diagnosis. Ultrasound scan may underestimate the tumor size. In a case of giant testicular tumor inguinal - scrotal approach should be considered. Despite the tumor size, the patient had no metastases beyond the lymphatic system.
Collapse
|
8
|
Rovito MJ, Craycraft M, Adams WB, Maresca M, Saab MM, Cary C, Gooljar C, Martinez S, Abu Zanet R. A Cross-Sectional Analysis of Testicular Cancer Symptom Recognition and Stage of Diagnosis. Am J Mens Health 2022; 16:15579883221104900. [PMID: 35723132 PMCID: PMC9344164 DOI: 10.1177/15579883221104900] [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] [Indexed: 11/17/2022] Open
Abstract
There is a need to further explore the relationship between atypical symptom
reporting and stage diagnosis to help develop a clearer defined list of possible
testicular cancer (TC) symptoms that could assist physicians diagnose the
disease earlier. A cross-sectional study was employed to explore possible
associations between TC symptom presentation and stage of diagnosis. An original
40-item survey was distributed among 698 TC survivors to determine the potential
impact of several risk factors, experiences, and behaviors upon diagnosis. This
analysis aimed to explore how certain patient-driven experiences (e.g.,
symptoms, perceptions, and behaviors) could serve as catalysts for seeking
medical care for testicular health concerns. Experiencing hot flashes or having
no symptoms had a positive association with later-stage diagnosis while change
in shape had a significant negative association with later-stage diagnosis.
While the logistic regression model explained relatively low variance in the
data (R2 = .1415), it was statistically significant
(χ2p < .001). Pain (odds ratio [OR] = 1.6524,
p < .05), hot flashes (OR = 5.7893, p
< .01), and no symptoms experienced (OR = 12.4836, p <
.01) were all significant predictors of a more advanced stage diagnosis. The
concern around uncommon/atypical symptoms are that they are indistinct and do
not serve as clear signs that TC is present. However, perhaps in tandem with
other more overt symptoms, their discovery can serve in a more confirmatory role
for a suspect case. If observed with other uncommonly reported symptoms, these
uncommon symptoms could provide another pathway in the TC diagnostic process.
Clinical and patient education is warranted to increase awareness of uncommon TC
symptoms.
Collapse
Affiliation(s)
- Michael J Rovito
- Testicular Cancer Research Collaborative, Department of Health Sciences, College of Health Professions and Sciences, University of Central Florida, Orlando, FL, USA
| | | | - Wesley B Adams
- Testicular Cancer Research Collaborative, Department of Health Sciences, College of Health Professions and Sciences, University of Central Florida, Orlando, FL, USA
| | - Michael Maresca
- Testicular Cancer Research Collaborative, Department of Health Sciences, College of Health Professions and Sciences, University of Central Florida, Orlando, FL, USA
| | - Mohamad M Saab
- Catherine McAuley School of Nursing and Midwifery, Brookfield Health Sciences Complex, University College Cork, Cork, Ireland
| | - Clint Cary
- Health Simon Cancer Center, Indiana University, Indianapolis, IN, USA
| | - Chayna Gooljar
- Testicular Cancer Research Collaborative, Department of Health Sciences, College of Health Professions and Sciences, University of Central Florida, Orlando, FL, USA
| | - Sydney Martinez
- Testicular Cancer Research Collaborative, Department of Health Sciences, College of Health Professions and Sciences, University of Central Florida, Orlando, FL, USA
| | - Rama Abu Zanet
- Testicular Cancer Research Collaborative, Department of Health Sciences, College of Health Professions and Sciences, University of Central Florida, Orlando, FL, USA
| |
Collapse
|
9
|
Dincer AN, Brunckhorst O, Genel O, Dasgupta P, Muneer A, Ahmed K. Quality of life, anxiety and depression patient-reported outcome measures in testicular cancer: A systematic review. Psychooncology 2021; 30:1420-1429. [PMID: 33934434 DOI: 10.1002/pon.5700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 03/26/2021] [Accepted: 04/06/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Several patient-reported outcome measures (PROMs) are available for the assessment of quality of life (QoL), anxiety and depression for testicular cancer (TCa); however, these PROMs have uncertain validation of their psychometric properties for TCa-only cohorts. This systematic review aims to critically analyse and evaluate the psychometric properties of these QoL, anxiety and depression PROMs. METHODS PubMed, EMBASE and PsycInfo were searched by two independent reviewers from inception to August 2020. Evaluative studies that assessed measurement properties of PROM(s) tools used for measuring QoL, anxiety and depression in TCa patients were included. The COnsensus-based Standards for the selection of health status Measurement Instruments (COSMIN) updated criteria for good measurement properties were used in the evaluation of PROM psychometric quality. This systematic review was registered on the PROSPERO database (CRD42020160232). RESULTS Of 4,305 abstracts screened, a final eight full-text articles were included in this review. Five general and two TCa-specific PROMs were identified (depression, n = 1; anxiety and depression, n = 2; QoL, n = 4). All studies were incomplete in the validation of nine measurement properties and the modal methodological quality was 'indeterminate'. The European Organisation for Research and Treatment of Cancer Quality -Testicular Cancer 26 questionnaire and CAYA-T had the highest psychometric validation with three out of nine measurement properties being 'sufficient'. CONCLUSION This systematic review identifies a paucity of PROM-validation studies assessing anxiety, depression and QoL in TCa-only cohorts. We recommend further comprehensive and standardised psychometric validation studies of QoL, anxiety and depression PROMs in TCa-only study populations.
Collapse
Affiliation(s)
- Amine Nur Dincer
- MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, UK
| | - Oliver Brunckhorst
- MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, UK
| | - Oktay Genel
- MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, UK
| | - Prokar Dasgupta
- MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, UK
| | - Asif Muneer
- Division of Surgery and Interventional Science, University College London, London, UK.,Department of Urology, Institute of Andrology, University College London Hospitals NHS Foundation Trust, London, UK.,NIHR Biomedical Research Centre, University College London Hospital, London, UK
| | - Kamran Ahmed
- MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, UK.,Department of Urology, King's College Hospital, London, UK
| |
Collapse
|
10
|
Huang MM, Cheaib JG, Su ZT, Biles MJ, Sharma R, Zhang A, Singla N, Bass EB, Pierorazio PM. Assessing quality of care in the diagnosis and treatment of early-stage testicular cancer: A critical review and summary. Urol Oncol 2021; 39:400-408. [PMID: 33642227 DOI: 10.1016/j.urolonc.2021.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 01/18/2021] [Accepted: 02/01/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To review the current literature on quality of care in the diagnosis and management of early-stage testicular cancer. METHODS PubMed, Embase, and the Cochrane Central Register of Controlled Trials were searched for studies on quality of care in testicular cancer diagnosis and management from January 1980 to August 2018. Major overlapping themes related to quality of care in the diagnosis and management of TGCT were identified and evidence related to these themes were abstracted. EVIDENCE 62 studies were included in the review. A number of themes were identified including (1) trends in survival and outcomes, (2) management patterns, (3) adherence to evidence-based clinical guidelines, (4) delays in care, (5) treatment complications and toxicities, (6) sociodemographic factors, (7) volume of patients treated, (8) gaps in provider knowledge and medical errors, and (9) multidisciplinary approaches to care. EVIDENCE SUMMARY As survival for patients with testicular cancer improves, there has been a greater emphasis on other components of quality of care, such as reducing treatment toxicity and minimizing delays in diagnosis. Efforts to meet these goals include encouragement of adherence to evidence-based guidelines, greater utilization of surveillance, and promotion of multidisciplinary team-based care. Although outcomes have improved, social determinants of health, such as insurance status, race, and geographical residence all may influence survival and cancer-related outcomes. Additionally, qualitative review indicates patients who receive care at high-volume institutions appear to experience better outcomes than those treated at smaller centers. CONCLUSIONS As outcomes and survival improve for patients with testicular cancer, quality of care has become an important consideration. Future avenues of research on this topic include identifying an appropriate balance between centralization of care and expanding access to underserved areas, minimizing delays in care, ensuring greater adherence to clinical guidelines, and addressing sociodemographic and racial disparities in outcomes.
Collapse
Affiliation(s)
- Mitchell M Huang
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Joseph G Cheaib
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Zhuo T Su
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Michael J Biles
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Ritu Sharma
- The Johns Hopkins Evidence-Based Practice Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Allen Zhang
- The Johns Hopkins Evidence-Based Practice Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Nirmish Singla
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Eric B Bass
- The Johns Hopkins Evidence-Based Practice Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Phillip M Pierorazio
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD.
| |
Collapse
|
11
|
Hari Dass P, B. Jameson M. Testicular cancer: a 13‐year retrospective review of ethnic disparities in the Waikato region, New Zealand. Intern Med J 2020; 50:1344-1349. [DOI: 10.1111/imj.14681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 11/01/2019] [Accepted: 11/02/2019] [Indexed: 11/30/2022]
Affiliation(s)
| | - Michael B. Jameson
- Waikato District Health Board Hamilton New Zealand
- Waikato Clinical Campus, University of Auckland Hamilton New Zealand
| |
Collapse
|
12
|
Mian BM, Siddiqui S, Ahmad AE. Management of urologic cancers during the pandemic and potential impact of treatment deferrals on outcomes. Urol Oncol 2020; 39:258-267. [PMID: 33129674 PMCID: PMC7598541 DOI: 10.1016/j.urolonc.2020.10.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 10/05/2020] [Accepted: 10/17/2020] [Indexed: 01/03/2023]
Abstract
The COVID-19 pandemic-related constraints on healthcare access have raised concerns about adverse outcomes from delayed treatment, including the risk of cancer progression and other complications. Further, concerns were raised about a potentially significant backlog of patients in need of cancer care due to the pandemic-related delays in healthcare, further exacerbating any potential adverse outcomes. Delayed access to surgery is particularly relevant to urologic oncology since one-third of new cancers in men (20% overall) arise from the genitourinary (GU) tract and surgery is often the primary treatment. Herein, we summarize the prepandemic literature on deferred surgery for GU cancers and risk of disease progression. The aforementioned data on delayed surgery were gathered in the context of systemic delays present in certain healthcare systems, or occasionally, due to planned deferral in suboptimal surgical candidates. These data provide indirect, but sufficient insight to develop triage schemas for prioritization of uro-oncological cases. Herein, we outline the extent to which the pandemic-related triage guidelines had influenced urologic practice in various regions. To study the adverse outcomes in the pandemic-era, a survey of urologic oncologists was conducted regarding modifications in their initial management of urologic cancers and any delay-related adverse outcomes. While the adverse effects directly from COVID-19 related delays will become apparent in the coming years, the results showing short-term outcomes are quite instructive. Since cancer care was assigned a higher priority at most centers, this strategy may have avoided significant delays in care and limited the anticipated negative impact of pandemic-related constraints.
Collapse
Affiliation(s)
- Badar M Mian
- Division of Urology, Albany Medical Center, Albany NY.
| | - Sana Siddiqui
- Division of Urology, Albany Medical Center, Albany NY
| | | |
Collapse
|
13
|
Shah P, Kim FJ, Mian BM. Genitourinary cancer management during a severe pandemic: Utility of rapid communication tools and evidence-based guidelines. BJUI COMPASS 2020; 1:45-59. [PMID: 32537615 PMCID: PMC7280667 DOI: 10.1002/bco2.18] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/06/2020] [Accepted: 05/06/2020] [Indexed: 01/03/2023] Open
Abstract
Objectives: To determine the usefulness of social media for rapid communication with experts to discuss strategies for prioritization and safety of deferred treatment for urologic malignancies during COVID‐19 pandemic, and to determine whether the discourse and recommendations made through discussions on social media (Twitter) were consistent with the current peer‐reviewed literature regarding the safety of delayed treatment. Methods: We reviewed and compiled the responses to our questions on Twitter regarding the management and safety of deferred treatment in the setting of COVID‐19 related constraints on non‐urgent care. We chronicled the guidance published on this subject by various health authorities and professional organizations. Further, we analyzed peerreviewed literature on the safety of deferred treatment (surgery or systemic therapy) to make made evidence‐based recommendations. Results: Due to the rapidly changing information about epidemiology and infectious characteristics of COVID‐19, the health authorities and professional societies guidance required frequent revisions which by design take days or weeks to produce. Several active discussions on Twitter provided real‐time updates on the changing landscape of the restrictions being placed on non‐urgent care. For separate discussion threads on prostate cancer and bladder cancer, dozens of specialists with expertise in treating urologic cancers could be engaged in providing their expert opinions as well as share evidence to support their recommendations. Our analysis of published studies addressing the safety and extent to which delayed cancer care does not compromise oncological outcome revealed that most prostate cancer care and certain aspects of the bladder and kidney cancer care can be safely deferred for 2‐6 months. Urothelial bladder cancer and advanced kidney cancer require a higher priority for timely surgical care. We did not find evidence to support the idea of using nonsurgical therapies, such as hormone therapy for prostate cancer or chemotherapy for bladder cancer for safer deferment of previously planned surgery. We noted that the comments and recommendations made by the participants in the Twitter discussions were generally consistent with our evidence‐based recommendations for safely postponing cancer care for certain types of urologic cancers. Conclusion: The use of social media platforms, such as Twitter, where the comments and recommendations are subject to review and critique by other specialists is not only feasible but quite useful in addressing the situations requiring urgent resolution, often supported by published evidence. In circumstances such as natural disasters, this may be a preferable approach than the traditional expert panels due to its ability to harness the collective intellect to available experts to provide responses and solutions in real‐time. These real‐time communications via Twitter provided sound guidance which was readily available to the public and participants, and was generally in concordance with the peerreviewed data on safety of deferred treatment.
Collapse
Affiliation(s)
- P Shah
- Department of Urology Mayo Clinic Rochester MN USA
| | - F J Kim
- Division of Urology University of Colorado Denver CO USA
| | - B M Mian
- Division of Urology Albany Medical Center Albany NY USA
| |
Collapse
|
14
|
Abhulimen V, Raphael EJ. Testicular Cancer at the University of Port Harcourt Teaching Hospital: A 10-year Retrospective Review. JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS 2019; 9:21-26. [PMID: 35520106 PMCID: PMC9063532 DOI: 10.4103/jwas.jwas_903_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 02/10/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Testicular cancers are rare malignancies. They are however very common in males aged 15-40 years. Reports of increasing incidence of testicular cancer in western countries have been noted. Despite the increasing incidence, mortality has remained low in these countries. There are few publications on the management of testicular tumors in Nigeria. AIM The aim of this study was to determine the hospital prevalence and highlight our experience in the management of patients with testicular cancer. MATERIALS AND METHODS This was a 10-year retrospective study on patients diagnosed with histologically confirmed testicular cancer from January 2009 to December 2018. The case records were retrieved. Data obtained included biodata, clinical presentation, investigations, treatment received and outcomes. Data analysis was carried out using SPSS version 20.0. RESULTS Eleven patients with testicular cancer were managed during the study period, constituting 0.01% of new cases seen in the hospital. Peak age was 20-29 years (54.55%), with a mean age of 29.27 ± 9.51yrs. The most common presentation was painless scrotal swelling, observed in nine (81.8%) patients. Nine (81.8%) patients presented six months or more after onset of symptoms with advanced disease. Distant metastasis was seen in two (18.2%) patients. Right sided disease was found in seven (63.6%) and left sided disease in four (36.4%). All had radical inguinal orchidectomy. The most common histological diagnosis was seminoma in 8 (72.7%) patients. All the subjects were offered four courses of chemotherapy with bleomycin, etoposide and cisplatin. However, only four (36.4%) completed the chemotherapy. A statistically significant association was observed between the duration of symptoms and the disease stage (P = 0.003), and between number of chemotherapy sessions and survival (P = 0.02). CONCLUSION Testicular cancer was an uncommon condition in the catchment area of the University of Port Harcourt Teaching Hospital, affecting relatively young men. The commonest presenting complaint was painless scrotal swelling. Most patients presented with Stage II disease, with seminoma being the commonest histopathology. All had surgical treatment; adjuvant chemotherapy improved 5-year survival. Public education is necessary to surmount sociocultural barriers to effective management of testicular tumors in our environment.
Collapse
Affiliation(s)
- V. Abhulimen
- Urology Division, Department of Surgery, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria
| | - E. J. Raphael
- Urology Division, Department of Surgery, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria
| |
Collapse
|
15
|
Pishgar F, Haj-Mirzaian A, Ebrahimi H, Saeedi Moghaddam S, Mohajer B, Nowroozi MR, Ayati M, Farzadfar F, Fitzmaurice C, Amini E. Global, regional and national burden of testicular cancer, 1990-2016: results from the Global Burden of Disease Study 2016. BJU Int 2019; 124:386-394. [PMID: 30953597 DOI: 10.1111/bju.14771] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To provide estimates of the global incidence, mortality and disability-adjusted life-years (DALYs) associated with testicular cancer (TCa) between 1990 and 2016, using findings from the Global Burden of Disease (GBD) 2016 study. MATERIALS AND METHODS For the GBD 2016 study, cancer registry data and a vital registration system were used to estimate TCa mortality. Mortality to incidence ratios were used to transform mortality estimates to incidence, and to estimate survival, which was then used to estimate 10-year prevalence. Prevalence was weighted using disability weights to estimate years lived with disability (YLDs). Age-specific mortality and a reference life expectancy were used to estimate years of life lost (YLLs). DALYs are the sum of YLDs and YLLs. RESULTS Global incidence of TCa showed a 1.80-fold increase from 37 231 (95% uncertainty interval [ UI] 36 116-38 515) in 1990 to 66 833 (95% UI 64 487-69 736) new cases in 2016. The age-standardized incidence rate also increased from 1.5 (95% UI 1.45-1.55) to 1.75 (95% UI 1.69-1.83) cases per 100 000. Deaths from TCa remained stable between 1990 and 2016 [1990: 8394 (95% UI 7980-8904), 2016: 8651 (95% UI 8292-9027)]. The TCa age-standardized death rate decreased between 1990 and 2016, from 0.39 (95% UI 0.37-0.41) to 0.25 (95% UI 0.24-0.26) per 100 000; however, the decreasing trend was not similar in all regions. Global TCa DALYs decreased by 2% and reached 391 816 (95% UI 372 360-412 031) DALYs in 2016. The age-standardized DALY rate also decreased globally between 1990 and 2016 (10.31 [95% UI 9.82-10.84]) per 100 000 in 2016). CONCLUSION Although the mortality rate for TCa has decreased over recent decades, large disparities still exist in TCa mortality, probably as a result of lack of access to healthcare and oncological treatment. Timely diagnosis of this cancer, by improving general awareness, should be prioritized. In addition, improving access to effective therapies and trained healthcare workforces in developing and under-developed areas could be the next milestones.
Collapse
Affiliation(s)
- Farhad Pishgar
- Non-Communicable Diseases Research Centre, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.,Uro-Oncology Research Centre, Tehran University of Medical Sciences, Tehran, Iran
| | - Arvin Haj-Mirzaian
- Uro-Oncology Research Centre, Tehran University of Medical Sciences, Tehran, Iran
| | - Hedyeh Ebrahimi
- Non-Communicable Diseases Research Centre, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sahar Saeedi Moghaddam
- Non-Communicable Diseases Research Centre, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.,Endocrinology and Metabolism Research Centre, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Bahram Mohajer
- Non-Communicable Diseases Research Centre, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Mohsen Ayati
- Uro-Oncology Research Centre, Tehran University of Medical Sciences, Tehran, Iran
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Centre, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Christina Fitzmaurice
- Institute for Health Metrics and Evaluation, Seattle, WA, USA.,Division of Haematology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Erfan Amini
- Uro-Oncology Research Centre, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
16
|
Vasconcellos VF, Bastos DA, Pereira AAL, Watarai GY, Pereira BR, de Godoy A, Almeida-Silva J, Muniz DQB, Guglielmetti GB, Nahas WC, Dzik C. Clinical Characteristics and Treatment Outcomes of Patients With Advanced Germ Cell Tumor Treated at a Tertiary Cancer Center in Brazil. J Glob Oncol 2019; 5:1-8. [PMID: 30779600 PMCID: PMC6426638 DOI: 10.1200/jgo.18.00170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Reported treatment outcomes for patients with advanced germ cell tumors (aGCT) are based mainly on series from developed nations. Data from low- and middle-income countries are underrepresented. MATERIAL AND METHODS From 2000 to 2015, a retrospective analysis identified 300 patients with aGCT treated at our institution. Kaplan-Meier methods were used for analysis of progression-free survival (PFS) and overall survival (OS) according to the International Germ Cell Consensus Classification Group (IGCCCG). RESULTS Patients’ median age was 28 years. According to the IGCCCG, 57% had good-, 18.3% intermediate-, and 24.7% poor-risk disease. Median α-fetoprotein levels were 2.9, 243, and 3,998 ng/mL, and those of human chorionic gonadotropin were 0.4, 113, and 301.5 mUI/mL in IGCCCG good-, intermediate-, and poor-risk groups, respectively. At a median 46 months of follow-up, 93 PFS events and 45 deaths had occurred and estimated 5-year PFS and OS were 69% and 85%, respectively, including 83% and 95.3% in good-risk, 70.9% and 83.6% in intermediate-risk, and 35.1% and 62.2% in poor-risk patients, respectively. In multivariable analysis, Eastern Cooperative Oncology Group performance status ≥ 2 was a significant independent prognostic factor with a hazard ratio of 2.58 (95% CI, 1.55 to 4.29; P < .001) and 6.20 (95% CI, 2.97 to 12.92; P < .001) for PFS and OS, respectively. CONCLUSION Brazilian patients with aGCT in this cohort had similar outcomes as patients in the IGCCCG database. In comparison with contemporary series, patients with intermediate- and poor-risk aGCT had slightly inferior PFS and OS, possibly due to a high percentage of patients with poor performance status and less use of high-dose chemotherapy.
Collapse
Affiliation(s)
| | - Diogo Assed Bastos
- Instituto do Cancer do Estado de São Paulo, São Paulo, Brazil.,Hospital Sírio-Libanês, São Paulo, Brazil
| | - Allan A Lima Pereira
- Instituto do Cancer do Estado de São Paulo, São Paulo, Brazil.,Hospital Sírio-Libanês, São Paulo, Brazil
| | | | | | | | | | - David Queiroz Borges Muniz
- Instituto do Cancer do Estado de São Paulo, São Paulo, Brazil.,Hospital Sírio-Libanês, São Paulo, Brazil
| | | | | | - Carlos Dzik
- Instituto do Cancer do Estado de São Paulo, São Paulo, Brazil.,Hospital Sírio-Libanês, São Paulo, Brazil
| |
Collapse
|
17
|
Adams WB, Rovito MJ, Craycraft M. The Connection Between Testicular Cancer, Minority Males, and Planned Parenthood. Am J Mens Health 2018; 12:1774-1783. [PMID: 30008248 PMCID: PMC6142153 DOI: 10.1177/1557988318786874] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Testicular cancer (TCa) is the most prevalent neoplasm diagnosed in males aged 15-40 years. Lack of access to care is a key impediment to early-stage TCa diagnosis. Health equity concerns arise, however, as poor access largely manifests within underserved male populations, therefore, placing them at a higher risk to develop late-stage TCa. Planned Parenthood Federation of America (PPFA) offers a myriad of male reproductive/sexual health care options, including TCa screening and referral services. Therefore, expanding these amenities in traditionally underserved communities may address the concern of TCa screening opportunities. An ecological analysis was performed using data from the United States Cancer Statistics, American Community Survey, and PPFA databases to assess the impact of TCa upon minority males, identify associations between PPFA services and minority males, and provide future implications on the role PPFA may play in bridging health-care access gaps pertaining to TCa screenings. Results indicate that states with higher rates of poverty and uninsured individuals, as well as specifically Black/African American males, have lower TCa incidence and limited access to screening services. PPFA service presence and Black/African American, as well as uninsured, males had a negative association but revealed positive correlations with TCa incidence. Considering the emerging TCa outcome disparities among minority males, expanding PPFA men's health services is crucial in providing affordable options to help identify testicular abnormalities that are early stage or carcinoma in situ. Many at-risk males have limited means to obtain TCa screening services. Expanding this discussion could provide a foundation for future advocacy.
Collapse
Affiliation(s)
- Wesley B Adams
- 1 Behavioral Health Research Group, College of Health and Public Affairs, Department of Health Professions, University of Central Florida, Orlando, FL, USA
| | - Michael J Rovito
- 1 Behavioral Health Research Group, College of Health and Public Affairs, Department of Health Professions, University of Central Florida, Orlando, FL, USA
| | | |
Collapse
|
18
|
Selection of men for investigation of possible testicular cancer in primary care: a large case-control study using electronic patient records. Br J Gen Pract 2018; 68:e559-e565. [PMID: 29970393 DOI: 10.3399/bjgp18x697949] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 03/06/2018] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Testicular cancer incidence has risen over the last two decades and is expected to continue to rise. There are no primary care studies on the clinical features of testicular cancer, with recent National Institute for Health and Care Excellence (NICE) guidance based solely upon clinical consensus. AIM To identify clinical features of testicular cancer and to quantify their risk in primary care patients, with the aim of improving the selection of patients for investigation. DESIGN AND SETTING A matched case-control study in males aged ≥17 years, using Clinical Practice Research Datalink records. METHOD Putative clinical features of testicular cancer were identified and analysed using conditional logistic regression. Positive predictive values (PPVs) were calculated for those aged <50 years. RESULTS In all, 1398 cases were available, diagnosed between 2000 and 2012, with 4956 age-, sex-, and practice-matched controls. Nine features were independently associated with testicular cancer, the top three being testicular swelling (odds ratio [OR] 280, 95% confidence interval [CI] = 110 to 690), testicular lump (OR 270, 95% CI = 100 to 740), and scrotal swelling (OR 170, 95% CI = 35 to 800). The highest PPV for 17-49-year-olds was testicular lump, at 2.5% (95% CI = 1.1 to 5.6). Combining testicular lump with testicular swelling or testicular pain produced PPVs of 17% and 10%, respectively. CONCLUSION Testicular enlargement carries a risk of cancer of 2.5% - close to the current 3% threshold in UK referral guidance. Contrary to traditional teaching, painful testicular enlargement may signify cancer. Some initial hydrocele diagnoses appear to be wrong, with missed cancers, suggesting an ultrasound may be useful when a hydrocele diagnosis is uncertain. These results support the existing NICE guidelines, and help to characterise when an ultrasound should be considered in symptomatic men.
Collapse
|
19
|
HASSANZADEH J, MIRAHMADIZADEH A, KARIMI M, REZAEIAN S. Survival Rate in Thalassemia Major Patients: Difference between Date of Diagnosis and Date of Birth as an Index Date for Calculating Follow Up. IRANIAN JOURNAL OF PUBLIC HEALTH 2018; 47:768-769. [PMID: 29922625 PMCID: PMC6005973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Affiliation(s)
- Jafar HASSANZADEH
- Research Center for Health Sciences, Department of Epidemiology, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza MIRAHMADIZADEH
- Dept. of Epidemiology, School of Health, Non-Communicable Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehran KARIMI
- Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shahab REZAEIAN
- Research Center for Environmental Determinants of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran, Dept. of Epidemiology, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran,Corresponding Author:
| |
Collapse
|
20
|
Ren JT, Li MY, Wang XW, Xue WQ, Ren ZF, Jia WH. Potential factors associated with clinical stage of nasopharyngeal carcinoma at diagnosis: a case-control study. CHINESE JOURNAL OF CANCER 2017; 36:71. [PMID: 28870229 PMCID: PMC5584009 DOI: 10.1186/s40880-017-0239-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 07/04/2017] [Indexed: 12/29/2022]
Abstract
Background In China, most patients with nasopharyngeal carcinoma (NPC) are diagnosed at a late stage and consequently have a poor prognosis. This study aimed to investigate potential factors associated with the clinical stage of NPC at diagnosis. Methods Data were obtained from 118 patients with early-stage NPC and 274 with late-stage NPC who were treated at Sun Yat-sen University Cancer Center between August 2014 and July 2015. Patients were individually matched by age, sex, and residence, and a conditional logistic regression model was applied to assess the associations of clinical stage at diagnosis with socioeconomic status indicators, knowledge of NPC, physical examinations, patient interval, and risk factors for NPC. Results Although knowledge of early NPC symptoms, smoking cessation, and patient interval were important factors, the number of cigarettes smoked per day, motorbike ownership, and physical examination exhibited the strongest associations with the clinical stage of NPC at diagnosis. Compared with smoking fewer than ten cigarettes a day, smoking 10–30 cigarettes [odds ratio (OR) 4.03; 95% confidence interval (CI) 1.11–14.68] or more than 30 cigarettes (OR 11.46; 95% CI 1.26–103.91) was associated with an increased risk of late diagnosis. Compared with not owning a motorbike, owning a motorbike (OR 0.38; 95% CI 0.23–0.64) was associated with early diagnosis. Subjects who underwent physical examinations were less likely to receive a late diagnosis than those who did not undergo examinations (OR 0.50; 95% CI 0.28–0.89). However, indicators of wealth were not significant factors. Conclusions Initiatives to improve NPC patient prognosis should aim to promote knowledge about early symptoms and detection, health awareness, and accessibility to health facilities among all patients, regardless of socioeconomic status.
Collapse
Affiliation(s)
- Jun-Ting Ren
- School of Public Health, Sun Yat-sen University, 74 Zhongshan 2nd Rd, Guangzhou, 510080, Guangdong, P. R. China
| | - Meng-Yu Li
- School of Public Health, Sun Yat-sen University, 74 Zhongshan 2nd Rd, Guangzhou, 510080, Guangdong, P. R. China
| | - Xiao-Wen Wang
- School of Public Health, Sun Yat-sen University, 74 Zhongshan 2nd Rd, Guangzhou, 510080, Guangdong, P. R. China
| | - Wen-Qiong Xue
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, 651 Dongfeng East Rd, Guangzhou, 510060, Guangdong, P. R. China
| | - Ze-Fang Ren
- School of Public Health, Sun Yat-sen University, 74 Zhongshan 2nd Rd, Guangzhou, 510080, Guangdong, P. R. China.
| | - Wei-Hua Jia
- School of Public Health, Sun Yat-sen University, 74 Zhongshan 2nd Rd, Guangzhou, 510080, Guangdong, P. R. China. .,State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, 651 Dongfeng East Rd, Guangzhou, 510060, Guangdong, P. R. China.
| |
Collapse
|
21
|
The role of Indonesian patients' health behaviors in delaying the diagnosis of nasopharyngeal carcinoma. BMC Public Health 2017; 17:510. [PMID: 28545416 PMCID: PMC5445307 DOI: 10.1186/s12889-017-4429-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 05/15/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND With an estimated 13,000 newly diagnosed patients per year, nasopharyngeal carcinoma (NPC) is one of the most common types of cancer in males in Indonesia. Moreover, most patients are diagnosed at an advanced stage of the disease. This study aimed to explore the health behaviors of patients diagnosed with NPC and the possible causes of patient delay in NPC diagnosis. METHODS A qualitative research method was used to gain better insight into patient behaviors. Twelve patients were interviewed using semi-structured interview guidelines. All interviews were recorded, transcribed verbatim and analyzed according to a standard content analysis framework. RESULTS Most patients had limited knowledge regarding NPC and its causes. Fifty percent of the patients had a delay of six months from the onset of symptoms to diagnosis. The main reason for this delay was the lack of awareness among the patients, which was influenced by their environment, economic status, family, culture, and religion. The perceived barriers to seeking medical help included direct non-medical costs not covered by health insurance, complex and time-consuming insurance and referral systems, and negative experiences in the past. Health insurance did motivate people to seek medical help. CONCLUSION This study provides additional insight into patients' motivations to delay seeking medical help and can facilitate the design of NPC education programs. To improve awareness of the abovementioned causes for delay, community-based education programs are highly warranted and should focus on the recognition of NPC symptoms and possible solutions to overcome the main barriers at an earlier disease stage.
Collapse
|
22
|
Bezan A, Posch F, Ploner F, Bauernhofer T, Pichler M, Szkandera J, Hutterer GC, Pummer K, Gary T, Samonigg H, Beyer J, Winder T, Hermanns T, Fankhauser CD, Gerger A, Stotz M. Risk stratification for venous thromboembolism in patients with testicular germ cell tumors. PLoS One 2017; 12:e0176283. [PMID: 28430804 PMCID: PMC5400272 DOI: 10.1371/journal.pone.0176283] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 04/07/2017] [Indexed: 11/18/2022] Open
Abstract
Background Patients with testicular germ cell tumors (TGCT) have an increased risk for venous thromboembolism (VTE). We identified risk factors for VTE in this patient cohort and developed a clinical risk model. Methods In this retrospective cohort study at the Medical University of Graz we included 657 consecutive TGCT patients across all clinical stages. A predictive model for VTE was developed and externally validated in 349 TGCT patients treated at the University Hospital Zurich. Results Venous thromboembolic events occurred in 34 (5.2%) patients in the Graz cohort. In univariable competing risk analysis, higher clinical stage (cS) and a retroperitoneal lymphadenopathy (RPLN) were the strongest predictors of VTE (p<0.0001). As the presence of a RPLN with more than 5cm in greatest dimension without coexisting visceral metastases is classified as cS IIC, we constructed an empirical VTE risk model with the following four categories (12-month-cumulative incidence): cS IA-B 8/463 patients (1.7%), cS IS-IIB 5/86 patients (5.9%), cS IIC 3/21 patients (14.3%) and cS IIIA-C 15/70 patients (21.4%). This risk model was externally validated in the Zurich cohort (12-month-cumulative incidence): cS IA-B (0.5%), cS IS-IIB (6.0%), cS IIC (11.1%) and cS IIIA-C (19.1%). Our model had a significantly higher discriminatory performance than a previously published classifier (RPLN-VTE-risk-classifier) which is based on the size of RPLN alone (AUC-ROC: 0.75 vs. 0.63, p = 0.007). Conclusions According to our risk stratification, TGCT patients with cS IIC and cS III disease have a very high risk of VTE and may benefit from primary thromboprophylaxis for the duration of chemotherapy.
Collapse
Affiliation(s)
- Angelika Bezan
- Division of Clinical Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- Research Unit Genetic Epidemiology and Pharmacogenetics, Medical University of Graz, Graz, Austria
| | - Florian Posch
- Division of Clinical Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- Research Unit Genetic Epidemiology and Pharmacogenetics, Medical University of Graz, Graz, Austria
| | - Ferdinand Ploner
- Division of Clinical Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Thomas Bauernhofer
- Division of Clinical Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- Center for Biomarker Research in Medicine (CBmed), Graz, Austria
| | - Martin Pichler
- Division of Clinical Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- Department of Experimental Therapeutics, The University of Texas, MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Joanna Szkandera
- Division of Clinical Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | | | - Karl Pummer
- Department of Urology, Medical University of Graz, Graz, Austria
| | - Thomas Gary
- Division of Angiology, Department of Internal Medicine, Medical University Graz, Graz, Austria
| | - Hellmut Samonigg
- Division of Clinical Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Joerg Beyer
- Department of Oncology, University Hospital Zürich, University of Zürich, Zürich, Switzerland
| | - Thomas Winder
- Department of Oncology, University Hospital Zürich, University of Zürich, Zürich, Switzerland
| | - Thomas Hermanns
- Department of Urology, University Hospital Zürich, University of Zürich, Zürich, Switzerland
| | - Christian D. Fankhauser
- Department of Urology, University Hospital Zürich, University of Zürich, Zürich, Switzerland
- * E-mail: (CDF); (AG)
| | - Armin Gerger
- Division of Clinical Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- Research Unit Genetic Epidemiology and Pharmacogenetics, Medical University of Graz, Graz, Austria
- Center for Biomarker Research in Medicine (CBmed), Graz, Austria
- * E-mail: (CDF); (AG)
| | - Michael Stotz
- Division of Clinical Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- Research Unit Genetic Epidemiology and Pharmacogenetics, Medical University of Graz, Graz, Austria
| |
Collapse
|
23
|
Comber H, De Camargo Cancela M, Haase T, Johnson H, Sharp L, Pratschke J. Affluence and Private Health Insurance Influence Treatment and Survival in Non-Hodgkin's Lymphoma. PLoS One 2016; 11:e0168684. [PMID: 27992551 PMCID: PMC5167407 DOI: 10.1371/journal.pone.0168684] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 12/05/2016] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND The aim of this study was to investigate inequalities in survival for non-Hodgkin's lymphoma (NHL), distinguishing between direct and indirect effects of patient, social and process-of-care factors. METHODS All cases of NHL diagnosed in Ireland in 2004-2008 were included. Variables describing patient, cancer, stage and process of care were included in a discrete-time model of survival using Structural Equation Modelling software. RESULTS Emergency admissions were more common in patients with co-morbid conditions or with more aggressive cancers, and less frequent for patients from more affluent areas. Aggressive morphology, female sex, emergency admission, increasing age, comorbidity, treatment in a high caseload hospital and late stage were associated with increased hazard of mortality. Private patients had a reduced hazard of mortality, mediated by systemic therapy, admission to high caseload hospitals and fewer emergency admissions. DISCUSSION The higher rate of emergency presentation, and consequent poorer survival, of uninsured patients, suggests they face barriers to early presentation. Social, educational and cultural factors may also discourage disadvantaged patients from consulting with early symptoms of NHL. Non-insured patients, who present later and have more emergency admissions would benefit from better access to diagnostic services. Older patients remain disadvantaged by sub-optimal treatment, treatment in non-specialist centres and emergency admission.
Collapse
Affiliation(s)
| | | | - Trutz Haase
- Social and Economic Consultant, Dublin, Ireland
| | - Howard Johnson
- Health & Wellbeing Directorate Health Intelligence Unit, Health Service Executive, Dublin, Ireland
| | - Linda Sharp
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Jonathan Pratschke
- Department of Economics and Statistics, University of Salerno, Salerno, Italy
| |
Collapse
|
24
|
Rovito MJ, Manjelievskaia J, Leone JE, Lutz MJ, Nangia A. From 'D' to 'I': A critique of the current United States preventive services task force recommendation for testicular cancer screening. Prev Med Rep 2016; 3:361-6. [PMID: 27419037 PMCID: PMC4929233 DOI: 10.1016/j.pmedr.2016.04.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Accepted: 04/20/2016] [Indexed: 12/02/2022] Open
Abstract
In 2004, the United States Preventive Services Task Force (USPSTF) gave testicular cancer (TCa) screening a ‘D’ recommendation, discouraging the use of this preventive service. The USPSTF suggested that screening, inclusive of testicular self-examination (TSE) and clinician examination, does not reduce TCa mortality rates and that the high risk of false positives could serve as a detriment to patient quality of life. Others suggests that TCa screening is ineffective at detecting early-stage cases of TCa and readily highlights a lack of empirical evidence demonstrating said efficacy. These assertions, however, stand in stark contrast to the widely held support of TCa screening among practicing public health professionals, advocacy groups, and clinicians. In this present study, a review was conducted of the methods and processes used by the USPSTF in their 2011 reaffirmation of the ‘D’ grade recommendation. The evidence base and commentary offered as to why TSE, as part of the overall recommendation for TCa screening, was given a ‘D’ grade were analyzed for logical reasoning and methodological rigor. Considering the methodological flaws and the veritable lack of evidence needed to grant a conclusive recommendation, the question is raised if the current ‘D’ grade for TCa screening (i.e. discourage the use of said service) should be changed to an ‘I’ statement (i.e. the balance of benefits and harms is indeterminate). Therefore the purpose of this paper is to present the evidence of TCa screening in the context of efficacy and prevention in order for the field to reassess its relative value. The USPSTF gave testicular cancer screening a ‘D’ rating, discouraging its practice. We discover methodological flaws and a lack of evidence needed to grant a D rating. The D rating contrasts with the widely held support of TCa screening among practitioners. The question is raised if the ‘D’ rating for TCa screening should be changed to an ‘I′ statement.
Collapse
Affiliation(s)
- Michael J Rovito
- College of Health and Public Affairs, Department of Health Professions, University of Central Florida, 12805 Pegasus Drive, HPA1 Room 269, Orlando, FL 32828, United States
| | - Janna Manjelievskaia
- Mayes College of Healthcare Business and Policy, Department of Health Policy and Public Health, University of the Sciences in Philadelphia, 600 S 43rd St, Philadelphia, PA 19104, United States
| | - James E Leone
- Department of Movement Arts, Health Promotion, and Leisure Studies, Bridgewater State University, Bridgewater, MA 02325, United States
| | - Michael J Lutz
- Michigan Institute of Urology, 6900 Orchard Lake Rd. West Bloomfield, MI 48322, United States
| | - Ajay Nangia
- Dept. of Urology, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160, United States
| |
Collapse
|