1
|
Chiu AS, Hoxha I, Jensen CB, Saucke MC, Pitt SC. Medical Maximizing Preferences and Beliefs About Cancer Among US Adults. JAMA Netw Open 2024; 7:e2417098. [PMID: 38874925 PMCID: PMC11179133 DOI: 10.1001/jamanetworkopen.2024.17098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 04/16/2024] [Indexed: 06/15/2024] Open
Abstract
Importance Medical overutilization contributes to significant health care expenditures and exposes patients to questionably beneficial surgery and unnecessary risk. Objectives To understand public attitudes toward medical utilization and the association of these attitudes with beliefs about cancer. Design, Setting, and Participants In this cross-sectional survey study conducted from August 26 to October 28, 2020, US-based, English-speaking adults were recruited from the general public using Prolific Academic, a research participant platform. Quota-filling was used to obtain a sample demographically representative of the US population. Adults with a personal history of cancer other than nonmelanoma skin cancer were excluded. Statistical analysis was completed in July 2022. Main Outcome and Measures Medical utilization preferences were characterized with the validated, single-item Maximizer-Minimizer Elicitation Question. Participants preferring to take action in medically ambiguous situations (hereafter referred to as "maximizers") were compared with those who leaned toward waiting and seeing (hereafter referred to as "nonmaximizers"). Beliefs and emotions about cancer incidence, survivability, and preventability were assessed using validated measures. Logistic regression modeled factors associated with preferring to maximize medical utilization. Results Of 1131 participants (mean [SD] age, 45 [16] years; 568 women [50.2%]), 287 (25.4%) were classified as maximizers, and 844 (74.6%) were classified as nonmaximizers. Logistic regression revealed that self-reporting very good or excellent health status (compared with good, fair, or poor; odds ratio [OR], 2.01 [95% CI, 1.52-2.65]), Black race (compared with White race; OR, 1.88 [95% CI, 1.22-2.89]), high levels of cancer worry (compared with low levels; OR, 1.62 [95% CI, 1.09-2.42]), and overestimating cancer incidence (compared with accurate estimation or underestimating; OR, 1.58 [95% CI, 1.09-2.28]) were significantly associated with maximizing preferences. Those who believed that they personally had a higher-than-average risk of developing cancer were more likely to be maximizers (23.6% [59 of 250] vs 17.4% [131 of 751]; P = .03); this factor was not significant in regression analyses. Conclusions and Relevance In this survey study of US adults, those with medical maximizing tendencies more often overestimated the incidence of cancer and had higher levels of cancer-related worry. Targeted and personalized education about cancer and its risk factors may help reduce overutilization of oncologic care.
Collapse
Affiliation(s)
- Alexander S Chiu
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison
| | - Ines Hoxha
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison
| | - Catherine B Jensen
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison
- Department of Surgery, University of Michigan, Ann Arbor
| | - Megan C Saucke
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison
| | - Susan C Pitt
- Department of Surgery, University of Michigan, Ann Arbor
| |
Collapse
|
2
|
Babu E, Sen S. Explore & actuate: the future of personalized medicine in oncology through emerging technologies. Curr Opin Oncol 2024; 36:93-101. [PMID: 38441149 DOI: 10.1097/cco.0000000000001016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
PURPOSE OF REVIEW The future of medicine is aimed to equip the physician with tools to assess the individual health of the patient for the uniqueness of the disease that separates it from the rest. The integration of omics technologies into clinical practice, reviewed here, would open new avenues for addressing the spatial and temporal heterogeneity of cancer. The rising cancer burden patiently awaits the advent of such an approach to personalized medicine for routine clinical settings. RECENT FINDINGS To weigh the translational potential, multiple technologies were categorized based on the extractable information from the different types of samples used, to the various omic-levels of molecular information that each technology has been able to advance over the last 2 years. This review uses a multifaceted classification that helps to assess translational potential in a meaningful way toward clinical adaptation. SUMMARY The importance of distinguishing technologies based on the flow of information from exploration to actuation puts forth a framework that allows the clinicians to better adapt a chosen technology or use them in combination to enhance their goals toward personalized medicine.
Collapse
Affiliation(s)
- Erald Babu
- UM-DAE Centre for Excellence in Basic Sciences, School of Biological Sciences, University of Mumbai, Kalina Campus, Mumbai, Maharashtra, India
| | | |
Collapse
|
3
|
Sachdev R, Shearn-Nance G, Vu L, Bensken WP, Douglas SL, Koroukian SM, Rose J. Comparing the use of aggressive end-of life care among frail and non-frail patients with cancer using a claims-based frailty index. J Geriatr Oncol 2024; 15:101706. [PMID: 38320468 DOI: 10.1016/j.jgo.2024.101706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 09/02/2023] [Accepted: 01/16/2024] [Indexed: 02/08/2024]
Abstract
INTRODUCTION Despite mounting consensus that end-of-life (EOL) care for patients with cancer should focus on improving quality of life, many patients continue to receive aggressive, disease-oriented treatment until death. Within this group, patients with increased frailty may be at higher risk of adverse treatment-related outcomes. We therefore examined the relationship between degree of frailty and receipt of aggressive EOL care among Medicare-insured patients with cancer in Ohio. MATERIALS AND METHODS From the Ohio Cancer Incidence Surveillance System (OCISS) linked with Medicare claims, we identified patients diagnosed with breast, colorectal, lung, or prostate cancer who died between 2012 and 2016. Frailty was operationalized using a validated claims-based frailty index. Six quality indicators reflecting receipt of aggressive EOL care were identified from claims: (1) any cancer-directed treatment, (2) >1 emergency department (ED) visit, (3) >1 hospital admission, (4) any intensive care unit (ICU) admission in the last 30 days of life, (5) entry to hospice in the last three days of life, and (6) in-hospital mortality. Multivariable logistic regression analysis was performed to control for demographic factors, Medicare and Medicaid dual enrollment, and cancer type and stage in the relationship between frailty and aggressive EOL care. RESULTS Overall, 31,465 patients met selection criteria. Patients with moderate/severe frailty were less likely than non-/pre-frail patients to receive any aggressive EOL care (adjusted odds ratio [aOR] 0.92 [95% confidence interval 0.86-0.99]). This group was also less likely to undergo cancer-directed treatment in their last 30 days or to enter hospice in their last three days. Increasing frailty was associated with lower odds of admission to the ICU in the last 30 days of life (mild frailty: aOR 0.88 [0.83-0.94]; moderate/severe frailty: aOR 0.85 [0.78-0.92]) or of dying in-hospital (mild frailty: 0.85 [0.79-0.91]; moderate/severe frailty: aOR 0.74 [0.67-0.82]), but higher odds of having >1 ED visit in the last 30 days of life (mild frailty: aOR 1.43 [1.32-1.53]; moderate/severe frailty: aOR 1.61 [1.47-1.77]). DISCUSSION These findings suggest the need for more explicit discussion of emergency care seeking for patients with cancer at the end of life.
Collapse
Affiliation(s)
- Rishi Sachdev
- Case Western Reserve University School of Medicine, 9501 Euclid Ave, Cleveland, OH, 44106, USA
| | - Galen Shearn-Nance
- Case Western Reserve University School of Medicine, 9501 Euclid Ave, Cleveland, OH, 44106, USA
| | - Long Vu
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, 10900 Euclid Avenue, WG-49, Cleveland, OH 44106-4945, USA
| | - Wyatt P Bensken
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, 10900 Euclid Avenue, WG-49, Cleveland, OH 44106-4945, USA
| | - Sara L Douglas
- Frances Payne Bolton School of Nursing, Case Western Reserve University, 10900 Euclid Ave., Cleveland, OH. 44104, USA
| | - Siran M Koroukian
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, 10900 Euclid Avenue, WG-49, Cleveland, OH 44106-4945, USA
| | - Johnie Rose
- Center for Community Health Integration, Case Western Reserve University School of Medicine, 11000 Cedar Ave., Ste. 402, Cleveland, OH 44106-7136, USA.
| |
Collapse
|
4
|
Lacey HP, Lacey SC, Dayal P, Forest C, Blasi D. Context Matters: Emotional Sensitivity to Probabilities and the Bias for Action in Cancer Treatment Decisions. Med Decis Making 2023; 43:417-429. [PMID: 36951184 PMCID: PMC10595072 DOI: 10.1177/0272989x231161341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
BACKGROUND Past studies have shown a commission bias for cancer treatment, a tendency to choose active treatment even when watchful waiting is less risky. This bias suggests motivations for action beyond mortality statistics, but recent evidence suggests that individuals differ in their emotional sensitivity to probabilities (ESP), the tendency to calibrate emotional reactions to probability. The current study aims to examine the role of ESP in the commission bias, specifically whether those higher in ESP are more likely to choose watchful waiting when risk probabilities align with that choice. METHODS Participants (N = 1,055) read a scenario describing a hypothetical cancer diagnosis and chose between surgery and watchful waiting, with random assignment between versions where the mortality rate was either lower for surgery or for watchful waiting. We modeled choice using the Possibility Probability Questionnaire (PPQ), a measure of ESP, and several other individual differences in a logistic regression. RESULTS We observed a commission bias as in past studies with most participants choosing surgery both when surgery was optimal (71%) and when watchful waiting was optimal (58%). An ESP × Condition interaction indicated that the predictive role of ESP depended on condition. Those higher in ESP were more likely to choose surgery when probabilities favored surgery, β = 0.57, P < 0.001, but when probabilities favored watchful waiting, ESP had a near-zero relationship with choice, β = 0.05, P < 0.99. CONCLUSIONS The role of ESP in decision making is context specific. Higher levels of ESP predict choosing action when that action is warranted but do not predict a shift away from surgery when watchful waiting offers better chances of survival. ESP does not overcome the commission bias. HIGHLIGHTS Past studies have identified a "commission bias," a tendency to choose active treatment over watchful waiting, even when mortality rate is lower for waiting.Evaluation of risk probabilities is related to individual differences in emotional sensitivity to probabilities (ESP) and has been shown to predict reactions to and decisions about health risk situations.ESP appears to be selectively factored into decision making. ESP was a robust predictor of choosing surgery when probability information supported surgery but did not predict decisions when probability information supported watchful waiting.Those who are most emotionally attuned to probabilities are just as susceptible to the commission bias as those who are less attuned.
Collapse
Affiliation(s)
- Heather P Lacey
- Department of Psychology, Center for Health and Behavioral Sciences, Bryant University, Smithfield, RI, USA
| | - Steven C Lacey
- Carroll School of Management, Boston University, Chestnut Hill, MA, USA
| | - Prerna Dayal
- Department of Psychology, Center for Health and Behavioral Sciences, Bryant University, Smithfield, RI, USA
| | - Caroline Forest
- Department of Psychology, Center for Health and Behavioral Sciences, Bryant University, Smithfield, RI, USA
| | - Dana Blasi
- Department of Psychology, Center for Health and Behavioral Sciences, Bryant University, Smithfield, RI, USA
| |
Collapse
|
5
|
Luna-Dulcey L, Almada da Silva J, Jimenez-Renard V, Caleiras E, Mouron S, Quintela-Fandino M, Cominetti MR. [6]-Gingerol-Derived Semi-Synthetic Compound SSi6 Inhibits Tumor Growth and Metastatic Dissemination in Triple-Negative Breast Cancer Xenograft Models. Cancers (Basel) 2021; 13:cancers13122855. [PMID: 34201040 PMCID: PMC8228746 DOI: 10.3390/cancers13122855] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 05/18/2021] [Accepted: 05/20/2021] [Indexed: 12/17/2022] Open
Abstract
Simple Summary Triple-negative breast cancers (TNBC) represent approximately 15% of all breast cancers and lack the expression of a defined molecular target. This absence makes this subtype of cancer difficult to treat and control. Current chemotherapy drugs cause various side effects and toxicities that can jeopardize the quality of life of patients with TNBC cancer. Therefore, this research focuses on a new semi-synthetic compound derived from [6]-gingerol, where we demonstrate that it does not cause significant toxic effects in vivo and, more importantly, we demonstrate its antitumor and antimetastatic effects using preclinical xenograft models simulating two clinical scenarios of a woman with breast cancer. Abstract Breast cancer metastasis is the most common cause of cancer death in women worldwide. Triple-negative breast cancers (TNBC) form a heterogeneous group of tumors that have higher relapse rates and poorer survival compared to other breast cancer subtypes. Thus, this work reports the antitumor and antimetastatic activities of a [6]-gingerol-derived semi-synthetic compound named SSi6 on MDA-MB-231 TNBC cells using xenograft models. SSi6 did not cause toxic effects in vivo as demonstrated by body weight and hematological and histological evaluations. From the orthotopic xenograft model, we demonstrated that SSi6 slows and inhibits the growth of the primary tumor, as well as prevents metastatic spontaneous progression from lymph nodes to the lungs. Moreover, a second xenograft model with resection of the primary tumor showed that SSi6 also blocks the progression of metastases from the lymph nodes to other visceral organs. Taken together, our results demonstrate that SSi6 is a promising compound to be investigated in other preclinical and clinical models to be applied as a complementary therapy for TNBC.
Collapse
Affiliation(s)
- Liany Luna-Dulcey
- Laboratory of Biology of Aging (LABEN), Department of Gerontology, Federal University of São Carlos (UFSCar), CEP 13565-905 São Carlos–SP, Brazil;
- Correspondence: ; Tel.: +55-16-3306-6672; Fax: +55-16-3351-9628
| | - James Almada da Silva
- Department of Pharmacy, Federal University of Sergipe (UFS), CEP 49400-000, Av. Gov. Marcelo Deda, 330–São José, Lagarto–SE, Brazil;
| | - Veronica Jimenez-Renard
- Breast Cancer Clinical Research Unit, Spanish National Cancer Research Center (CNIO), CP 28029 Madrid, Spain; (V.J.-R.); (S.M.); (M.Q.-F.)
| | - Eduardo Caleiras
- Histopathology Unit, Spanish National Cancer Research Center (CNIO), CP 28029 Madrid, Spain;
| | - Silvana Mouron
- Breast Cancer Clinical Research Unit, Spanish National Cancer Research Center (CNIO), CP 28029 Madrid, Spain; (V.J.-R.); (S.M.); (M.Q.-F.)
| | - Miguel Quintela-Fandino
- Breast Cancer Clinical Research Unit, Spanish National Cancer Research Center (CNIO), CP 28029 Madrid, Spain; (V.J.-R.); (S.M.); (M.Q.-F.)
| | - Marcia R. Cominetti
- Laboratory of Biology of Aging (LABEN), Department of Gerontology, Federal University of São Carlos (UFSCar), CEP 13565-905 São Carlos–SP, Brazil;
| |
Collapse
|
6
|
Bhattacharyya GS, Doval DC, Desai CJ, Chaturvedi H, Sharma S, Somashekhar S. Overview of Breast Cancer and Implications of Overtreatment of Early-Stage Breast Cancer: An Indian Perspective. JCO Glob Oncol 2020; 6:789-798. [PMID: 32511068 PMCID: PMC7328098 DOI: 10.1200/go.20.00033] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2020] [Indexed: 12/15/2022] Open
Abstract
The prevalence and mortality of breast cancer is increasing in Asian countries, including India. With advances in medical technology leading to better detection and characterization of the disease, it has been possible to classify breast cancer into various subtypes using markers, which helps predict the risk of distant recurrence, response to therapy, and prognosis using a combination of molecular and clinical parameters. Breast cancer and its therapy, mainly surgery, systemic therapy (anticancer chemotherapy, hormonal therapy, targeted therapy, and immunotherapy), and radiation therapy, are associated with significant adverse influences on physical and mental health, quality of life, and the economic status of the patient and her family. The fear of recurrence and its devastating effects often leads to overtreatment, with a toxic cost to the patient financially and physically in cases in which this is not required. This article discusses some aspects of a breast cancer diagnosis and its impact on the various facets of the life of the patient and her family. It further elucidates the role of prognostic factors, the currently available biomarkers and prognostic signatures, and the importance of ethnically validating biomarkers and prognostic signatures.
Collapse
Affiliation(s)
| | - Dinesh C. Doval
- Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Chirag J. Desai
- Vedanta Institute of Medical Sciences, Ahmedabad, Gujarat, India
| | | | - Sanjay Sharma
- Asian Cancer Institute, Somaiya Ayurvihar, Mumbai, Maharashtra, India
| | - S.P. Somashekhar
- Department of Surgical Oncology, Manipal Comprehensive Cancer Center, Manipal Hospital, Bengaluru, India
| |
Collapse
|
7
|
Teufel M, Dörrie N, Skoda EM. [The influence of the pathologist on the mental well-being of the patient]. DER PATHOLOGE 2019; 40:347-349. [PMID: 31705241 DOI: 10.1007/s00292-019-00687-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The label cancer in itself leads to complex psychological reactions in patients that are closely related to previous experiences and self-image. A cancer diagnosis can lead to increased distress and subsequent mental comorbidity such as depression or anxiety disorders. The responsibility of the pathologist, as the person who first uses the label cancer, is high. The pathologist must be conscious and focus not only on the accuracy of the anatomical pathology, but also on the potential influences the wording may have on the mental health of the patient. The word "carcinoma" should only be used in the case of tumors with the respective biological behavior. The example of non-invasive follicular thyroid neoplasm with papillary-like nuclear features shows that changing a label can lead to an improvement in distress and quality of life.
Collapse
Affiliation(s)
- M Teufel
- Klinik für Psychosomatische Medizin und Psychotherapie, Psychoonkologie am Westdeutschen Tumorzentrum, LVR-Klinikum Essen, Klinik und Institut der Universität Duisburg Essen, Virchowstr. 174, 45147, Essen, Deutschland.
| | - N Dörrie
- Klinik für Psychosomatische Medizin und Psychotherapie, Psychoonkologie am Westdeutschen Tumorzentrum, LVR-Klinikum Essen, Klinik und Institut der Universität Duisburg Essen, Virchowstr. 174, 45147, Essen, Deutschland
| | - E-M Skoda
- Klinik für Psychosomatische Medizin und Psychotherapie, Psychoonkologie am Westdeutschen Tumorzentrum, LVR-Klinikum Essen, Klinik und Institut der Universität Duisburg Essen, Virchowstr. 174, 45147, Essen, Deutschland
| |
Collapse
|
8
|
Young RP, Hopkins R. The potential impact of chronic obstructive pulmonary disease in lung cancer screening: implications for the screening clinic. Expert Rev Respir Med 2019; 13:699-707. [PMID: 31274043 DOI: 10.1080/17476348.2019.1638766] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Introduction: Following the findings of the National Lung Screening Trial (NLST), lung cancer screening is now recommended in the United States. However, post-hoc analyses of the NLST suggest that reducing lung cancer mortality through screening is highly dependent on the underlying characteristics of the screening participants, in particular, the presence of chronic obstructive pulmonary disease (COPD). Areas covered: In this review, we outline how outcomes in lung cancer screening are significantly affected by the presence of airflow limitation, as caused by COPD, and how this might impact the assessment of eligible smokers in a lung cancer screening clinic. Expert opinion: There is growing evidence showing that CT-based screening for lung cancer reduces lung cancer mortality. The benefits of screening exceed those seen in the NLST when screening is carried out in lower risk populations, for a longer duration, and when outcomes are compared with usual care control cohorts. In this article, we review data from a post-hoc analysis of the NLST. We suggest that whilst worsened airflow limitation is associated with greater lung cancer risk, there is also more aggressive lung cancer, reduced lung cancer operability, and for advanced COPD, reduced benefits from screening. We advocate an 'outcomes-based' approach to screening over a 'risk-based' approach.
Collapse
Affiliation(s)
- Robert P Young
- a School of Biological Sciences, University of Auckland , Auckland , New Zealand.,b Faculty of Medical and Health Sciences, University of Auckland , Auckland , New Zealand
| | - Raewyn Hopkins
- b Faculty of Medical and Health Sciences, University of Auckland , Auckland , New Zealand
| |
Collapse
|
9
|
Heath EI, Nanus DM, Slovin S, Strand C, Higano C, Simons VH, Johnson C, Kyriakopoulos CE, Reichert ZR, Lory S, George DJ, Mucci LA, Marcus JD, Trendel JA, Bock CH. Prostate Cancer National Summit's Call to Action. Clin Genitourin Cancer 2019; 17:161-168. [PMID: 31085057 DOI: 10.1016/j.clgc.2019.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 04/01/2019] [Accepted: 04/09/2019] [Indexed: 10/27/2022]
Affiliation(s)
- Elisabeth I Heath
- Karmanos Cancer Institute and Department of Oncology, Wayne State University School of Medicine, Detroit, MI.
| | - David M Nanus
- Division of Hematology and Oncology, Department of Medicine, Weill Cornell Medicine and Meyer Cancer Center, New York, NY
| | - Susan Slovin
- Sidney Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Celestia Higano
- Fred Hutchinson Cancer Research Center and Division of Medical Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, WA
| | | | - Crawford Johnson
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, and Sidney Kimmel Comprehensive Cancer Center, Department of Urology, Johns Hopkins University, Baltimore, MD
| | - Christos E Kyriakopoulos
- Division of Hematology/Oncology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Zachery R Reichert
- Division of Hematology/Oncology, Department of Internal Medicine and University of Michigan Comprehensive Cancer Center, Ann Arbor, MI
| | | | - Daniel J George
- Division of Medical Oncology, Department of Medicine and Duke Cancer Institute, Duke University Medical Center, Durham, NC
| | - Lorelei A Mucci
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA
| | | | - Jill A Trendel
- Karmanos Cancer Institute and Department of Oncology, Wayne State University School of Medicine, Detroit, MI
| | - Cathryn H Bock
- Karmanos Cancer Institute and Department of Oncology, Wayne State University School of Medicine, Detroit, MI
| |
Collapse
|
10
|
Wegier P, Armstrong BA, Shaffer VA. Aiding Risk Information learning through Simulated Experience (ARISE): A Comparison of the Communication of Screening Test Information in Explicit and Simulated Experience Formats. Med Decis Making 2019; 39:196-207. [PMID: 30819033 DOI: 10.1177/0272989x19832882] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To determine whether the use of Aiding Risk Information learning through Simulated Experience (ARISE) to communicate conditional probabilities about maternal serum screening results for Down syndrome promotes more accurate positive predictive value (PPV) estimates and conceptual understanding of screening, compared with explicitly providing individuals with this information via numerical summary or icon array. METHOD In experiment 1, 582 participants completed an online study in which they were asked to estimate the PPV and rate their attitudes toward a screening test when information was presented in either a description (required calculation of the PPV), explicit (PPV was provided and had to be identified), or an ARISE format (PPV was inferred through experience-based learning). In experiment 2, 316 participants estimated the PPV and rated their attitudes toward screening based on information presented in either an icon array (identify the icons that represent the PPV) or ARISE format. RESULTS In experiment 1, ARISE elicited the most accurate PPV estimates compared with the description and explicit formats, and both the explicit and ARISE formats led to more unfavorable attitudes toward screening. In experiment 2, both the icon array and ARISE resulted in similar PPV estimates; however, ARISE led to more negative attitudes toward screening. CONCLUSIONS These findings suggest that ARISE may be superior to other formats in the communication of PPV information for screening tests. However, differences in the complexity of the formats vary and require further investigation.
Collapse
Affiliation(s)
- Pete Wegier
- Temmy Latner Centre for Palliative Care, Sinai Health System, Toronto, ON, Canada.,Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, ON, Canada.,Department of Family & Community Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Victoria A Shaffer
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA
| |
Collapse
|
11
|
Smith JC, Sheltzer JM. Systematic identification of mutations and copy number alterations associated with cancer patient prognosis. eLife 2018; 7:e39217. [PMID: 30526857 PMCID: PMC6289580 DOI: 10.7554/elife.39217] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 11/12/2018] [Indexed: 02/06/2023] Open
Abstract
Successful treatment decisions in cancer depend on the accurate assessment of patient risk. To improve our understanding of the molecular alterations that underlie deadly malignancies, we analyzed the genomic profiles of 17,879 tumors from patients with known outcomes. We find that mutations in almost all cancer driver genes contain remarkably little information on patient prognosis. However, CNAs in these same driver genes harbor significant prognostic power. Focal CNAs are associated with worse outcomes than broad alterations, and CNAs in many driver genes remain prognostic when controlling for stage, grade, TP53 status, and total aneuploidy. By performing a meta-analysis across independent patient cohorts, we identify robust prognostic biomarkers in specific cancer types, and we demonstrate that a subset of these alterations also confer specific therapeutic vulnerabilities. In total, our analysis establishes a comprehensive resource for cancer biomarker identification and underscores the importance of gene copy number profiling in assessing clinical risk.
Collapse
|
12
|
Zanchetta MS, Cognet M, Lam-Kin-Teng MR, Dumitriu ME, Haag C, Kadio B, Desgrandchamps F, Rénaud L. Insights for public education provided by French media on ideas about prostate cancer – A media analysis study. Health Promot Perspect 2018; 8:92-101. [PMID: 29744304 PMCID: PMC5935823 DOI: 10.15171/hpp.2018.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Accepted: 02/28/2018] [Indexed: 11/09/2022] Open
Abstract
Background: This study explored the French media’s presentation of ideas and medical information about prostate cancer (PC) that may influence men’s understanding, attitudes and behavior. Methods: A qualitative media content analysis centered on PC information delivered by French professional media. The selected data were produced in the aftermath of the High Health Authority's decision in 2008 not to recommend systematic screening by prostate specific antigen(PSA) for men over 50. Source was the Media Archives of the French National Library. Content was analyzed from 15 television programs, 14 radio programs, and 55 articles from 35 popular French newspapers (online and printed, weekly and monthly) and 20 magazines. Audio content was narrated into textual form and submitted to manual coding along with the print content. Results: Television and radio content focused on the nature of PC, screening and treatment,and conveyed a gender-centric position linked to male sexuality and virility. Newspapers and magazines targeted the testing controversy, the lack of consensus among professionals, and scientific advances in screening and treatment. Conclusion: Media participation in the European testing debate is valuable for allowing patients to hear all opinions on PC risk factors. Debate on testing policy contributes to confusion and uncertainty regarding appropriate action.
Collapse
Affiliation(s)
| | - Marguerite Cognet
- Unité de Formation et Recherche Sciences Sociales, Université Denis Diderot, Paris, France
| | | | | | - Carlos Haag
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, Canada
| | - Bernard Kadio
- Interdisciplinary School of Health Sciences- University of Ottawa, Ottawa, Canada
| | | | - Lise Rénaud
- Faculté de communication, Université du Québec à Montréal, Montréal, Canada
- Corresponding Author:
Margareth S. Zanchetta, PhD,
RN; Daphne Cockwell School
of Nursing-Ryerson University,
350 Victoria St. Office POD
474A, Toronto, ON M5B 2K3
Canada.
| |
Collapse
|
13
|
Laliberté M. Facteurs influençant la multiplication de traitements en physiothérapie : une analyse thématique de la jurisprudence québécoise. BIOÉTHIQUEONLINE 2018. [DOI: 10.7202/1044610ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
La physiothérapie est touchée par un problème de multiplication de traitements; la fréquence des traitements ou leur durée peuvent être inappropriées ou disproportionnées face aux besoins du patient. La multiplication de traitements peut avoir des conséquences financières, physiques, psychologiques et sociales. Pour explorer les facteurs influençant la fréquence et la durée des traitements dans les situations de multiplication de traitements, une analyse thématique de la jurisprudence a été réalisée. Certains facteurs cliniques et non cliniques influençant la fréquence et la durée des traitements ont pu être identifiés par cette analyse thématique de la jurisprudence. Les facteurs cliniques impliquent que l’allocation des ressources soit guidée par la condition et l’évolution du patient. Les facteurs non cliniques peuvent inclure la pression des employeurs, les demandes des autres professionnels de la santé ou les conflits d’intérêts de type financier. Cette analyse thématique de la jurisprudence est une première étape pour comprendre ce qui motive les décisions cliniques d’allocation des ressources des professionnels de la physiothérapie. Cette démarche est essentielle pour mettre en place des politiques et des normes de pratique soucieuses du contexte de pratique et des normes éthiques, déontologiques et légales qui animent la profession.
Collapse
Affiliation(s)
- Maude Laliberté
- École de réadaptation, Faculté de médecine, Université de Montréal, Montréal, Canada
- Programmes de bioéthique, Département de médecine sociale et préventive, École de santé publique de l’Université de Montréal
- Membre étudiant de l’Institut de recherche en santé publique de l’Université de Montréal (IRSPUM)
- Membre étudiant du Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain (CRIR)
| |
Collapse
|
14
|
Armstrong B, Spaniol J, Persaud N. Does exposure to simulated patient cases improve accuracy of clinicians' predictive value estimates of diagnostic test results? A within-subjects experiment at St Michael's Hospital, Toronto, Canada. BMJ Open 2018; 8:e019241. [PMID: 29440215 PMCID: PMC5829891 DOI: 10.1136/bmjopen-2017-019241] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE Clinicians often overestimate the probability of a disease given a positive test result (positive predictive value; PPV) and the probability of no disease given a negative test result (negative predictive value; NPV). The purpose of this study was to investigate whether experiencing simulated patient cases (ie, an 'experience format') would promote more accurate PPV and NPV estimates compared with a numerical format. DESIGN Participants were presented with information about three diagnostic tests for the same fictitious disease and were asked to estimate the PPV and NPV of each test. Tests varied with respect to sensitivity and specificity. Information about each test was presented once in the numerical format and once in the experience format. The study used a 2 (format: numerical vs experience) × 3 (diagnostic test: gold standard vs low sensitivity vs low specificity) within-subjects design. SETTING The study was completed online, via Qualtrics (Provo, Utah, USA). PARTICIPANTS 50 physicians (12 clinicians and 38 residents) from the Department of Family and Community Medicine at St Michael's Hospital in Toronto, Canada, completed the study. All participants had completed at least 1 year of residency. RESULTS Estimation accuracy was quantified by the mean absolute error (MAE; absolute difference between estimate and true predictive value). PPV estimation errors were larger in the numerical format (MAE=32.6%, 95% CI 26.8% to 38.4%) compared with the experience format (MAE=15.9%, 95% CI 11.8% to 20.0%, d=0.697, P<0.001). Likewise, NPV estimation errors were larger in the numerical format (MAE=24.4%, 95% CI 14.5% to 34.3%) than in the experience format (MAE=11.0%, 95% CI 6.5% to 15.5%, d=0.303, P=0.015). CONCLUSIONS Exposure to simulated patient cases promotes accurate estimation of predictive values in clinicians. This finding carries implications for diagnostic training and practice.
Collapse
Affiliation(s)
- Bonnie Armstrong
- Department of Psychology, Ryerson University, Toronto, Ontario, Canada
| | - Julia Spaniol
- Department of Psychology, Ryerson University, Toronto, Ontario, Canada
| | - Nav Persaud
- Department of Family and Community Medicine, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
15
|
Wang SY, Kelly G, Gross C, Killelea BK, Mougalian S, Presley C, Fraenkel L, Evans SB. Information Needs of Older Women With Early-Stage Breast Cancer When Making Radiation Therapy Decisions. Int J Radiat Oncol Biol Phys 2017; 98:733-740. [PMID: 28366581 DOI: 10.1016/j.ijrobp.2017.02.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 01/19/2017] [Accepted: 02/01/2017] [Indexed: 01/07/2023]
Abstract
PURPOSE To identify the information older women with early-stage breast cancer need when making radiation therapy decisions, and who patients identify as the main decision maker. METHODS AND MATERIALS We surveyed (through face-to-face interview, telephone, or mail) women aged ≥65 years who received lumpectomy and were considering or receiving adjuvant radiation therapy for early-stage breast cancer. The survey instrument was constructed with input from patient and professional advisory committees, including breast cancer survivors, advocates of breast cancer care and aging, clinicians, and researchers. Participants rated the importance (on a 4-point scale) of 24 statements describing the benefits, side effects, impact on daily life, and other issues of radiation therapy in relation to radiation therapy decision making. Participants also designated who was considered the key decision maker. RESULTS The response rate was 56.4% (93 of 165). Mean age was 72.5 years, ranging from 65 to 93 years. More than 96% of participants indicated they were the main decision maker on receiving radiation therapy. There was wide variation in information needs regarding radiation therapy decision making. Participants rated a mean of 18 (range, 3-24) items as "essential." Participants rated items related to benefits highest, followed by side effects. Participants who were older than 75 years rated 13.9 questions as essential, whereas participants aged ≤74 years rated 18.7 as essential (P=.018). CONCLUSIONS Older women desire information and have more agency and input in the decision-making process than prior literature would suggest. The variation in information needs indicates that future decision support tools should provide options to select what information would be of interest to the participants.
Collapse
Affiliation(s)
- Shi-Yi Wang
- Department of Chronic Disease Epidemiology, Yale University School of Public Health, New Haven, Connecticut; Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale Cancer Center and Yale University School of Medicine, New Haven, Connecticut.
| | - Gabrielle Kelly
- Department of Chronic Disease Epidemiology, Yale University School of Public Health, New Haven, Connecticut
| | - Cary Gross
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale Cancer Center and Yale University School of Medicine, New Haven, Connecticut; Section of General Internal Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Brigid K Killelea
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale Cancer Center and Yale University School of Medicine, New Haven, Connecticut; Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Sarah Mougalian
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale Cancer Center and Yale University School of Medicine, New Haven, Connecticut; Section of Medical Oncology, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Carolyn Presley
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale Cancer Center and Yale University School of Medicine, New Haven, Connecticut; Section of Medical Oncology, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Liana Fraenkel
- Section of Rheumatology, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Suzanne B Evans
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale Cancer Center and Yale University School of Medicine, New Haven, Connecticut; Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut
| |
Collapse
|
16
|
Wallner LP, Hawley ST. Communicating Disease-Specific Knowledge to Patients: An Overlooked Aspect of Personalized Medicine. J Oncol Pract 2016; 12:497-8. [PMID: 27165486 DOI: 10.1200/jop.2016.012237] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Lauren P. Wallner
- University of Michigan; and Ann Arbor Veterans Affairs Center for Clinical Management Research, Ann Arbor, MI
| | - Sarah T. Hawley
- University of Michigan; and Ann Arbor Veterans Affairs Center for Clinical Management Research, Ann Arbor, MI
| |
Collapse
|