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Cruz-Lim EM, Mou B, Baker S, Arbour G, Stefanyk K, Jiang W, Liu M, Bergman A, Schellenberg D, Alexander A, Berrang T, Bang A, Chng N, Matthews Q, Carolan H, Hsu F, Miller S, Atrchian S, Chan E, Ho C, Mohamed I, Lin A, Huang V, Mestrovic A, Hyde D, Lund C, Pai H, Valev B, Lefresne S, Tyldesley S, Olson R. Prospective Longitudinal Assessment of Quality of Life After Stereotactic Ablative Radiotherapy for Oligometastases: Analysis of the Population-based SABR-5 Phase II Trial. Clin Oncol (R Coll Radiol) 2024; 36:148-156. [PMID: 38087705 DOI: 10.1016/j.clon.2023.11.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 11/11/2023] [Accepted: 11/28/2023] [Indexed: 02/18/2024]
Abstract
AIMS To evaluate longitudinal patient-reported quality of life (QoL) in patients treated with stereotactic ablative radiotherapy (SABR) for oligometastases. MATERIALS AND METHODS The SABR-5 trial was a population-based single-arm phase II study of SABR to up to five sites of oligometastases, conducted in six regional cancer centres in British Columbia, Canada from 2016 to 2020. Prospective QoL was measured using treatment site-specific QoL questionnaires at pre-treatment baseline and at 3, 6, 9, 12, 15, 18, 21, 24, 30 and 36 months after treatment. Patients with bone metastases were assessed with the Brief Pain Inventory (BPI). Patients with liver, adrenal and abdominopelvic lymph node metastases were assessed with the Functional Assessment of Chronic Illness Therapy-Abdominal Discomfort (FACIT-AD). Patients with lung and intrathoracic lymph node metastases were assessed with the Prospective Outcomes and Support Initiative (POSI) lung questionnaire. The two one-sided test procedure was used to assess equivalence between the worst QoL score and the baseline score of individual patients. The mean QoL at all time points was used to determine the trajectory of QoL response after SABR. The proportion of patients with 'stable', 'improved' or 'worsened' QoL was determined for all time points based on standard minimal clinically important differences (MCID; BPI worst pain = 2, BPI functional interference score [FIS] = 0.5, FACIT-AD Trial Outcome Index [TOI] = 8, POSI = 3). RESULTS All enrolled patients with baseline QoL assessment and at least one follow-up assessment were analysed (n = 133). On equivalence testing, the patients' worst QoL scores were clinically different from baseline scores and met MCID (BPI worst pain mean difference: 1.8, 90% confidence interval 1.19 to 2.42]; BPI FIS mean difference: 1.68, 90% confidence interval 1.15 to 2.21; FACIT-AD TOI mean difference: -8.76, 90% confidence interval -11.29 to -6.24; POSI mean difference: -4.61, 90% confidence interval -6.09 to -3.14). However, the mean FIS transiently worsened at 9, 18 and 21 months but eventually returned to stable levels. The mean FACIT and POSI scores also worsened at 36 months, albeit with a limited number of responses (n = 4 and 8, respectively). Most patients reported stable QoL at all time points (range: BPI worst pain 71-82%, BPI FIS 45-78%, FACIT-AD TOI 50-100%, POSI 25-73%). Clinically significant stability, worsening and improvement were seen in 70%/13%/18% of patients at 3 months, 53%/28%/19% at 18 months and 63%/25%/13% at 36 months. CONCLUSIONS Transient decreases in QoL that met MCID were seen between patients' worst QoL scores and baseline scores. However, most patients experienced stable QoL relative to pre-treatment levels on long-term follow-up. Further studies are needed to characterise patients at greatest risk for decreased QoL.
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Affiliation(s)
- E M Cruz-Lim
- University of British Columbia, British Columbia, Canada; BC Cancer - Kelowna, Kelowna, British Columbia, Canada
| | - B Mou
- University of British Columbia, British Columbia, Canada; BC Cancer - Kelowna, Kelowna, British Columbia, Canada
| | - S Baker
- University of British Columbia, British Columbia, Canada; BC Cancer - Surrey, Surrey, British Columbia, Canada
| | - G Arbour
- University of British Columbia, British Columbia, Canada
| | - K Stefanyk
- University of British Columbia, British Columbia, Canada
| | - W Jiang
- University of British Columbia, British Columbia, Canada; BC Cancer - Surrey, Surrey, British Columbia, Canada
| | - M Liu
- University of British Columbia, British Columbia, Canada; BC Cancer - Vancouver, Vancouver, British Columbia, Canada
| | - A Bergman
- University of British Columbia, British Columbia, Canada; BC Cancer - Vancouver, Vancouver, British Columbia, Canada
| | - D Schellenberg
- University of British Columbia, British Columbia, Canada; BC Cancer - Surrey, Surrey, British Columbia, Canada
| | - A Alexander
- University of British Columbia, British Columbia, Canada; BC Cancer - Victoria, Victoria, British Columbia, Canada
| | - T Berrang
- University of British Columbia, British Columbia, Canada; BC Cancer - Victoria, Victoria, British Columbia, Canada
| | - A Bang
- University of British Columbia, British Columbia, Canada; BC Cancer - Vancouver, Vancouver, British Columbia, Canada
| | - N Chng
- BC Cancer - Prince George, Prince George, British Columbia, Canada
| | - Q Matthews
- BC Cancer - Prince George, Prince George, British Columbia, Canada
| | - H Carolan
- University of British Columbia, British Columbia, Canada; BC Cancer - Vancouver, Vancouver, British Columbia, Canada
| | - F Hsu
- University of British Columbia, British Columbia, Canada; BC Cancer - Abbotsford, Abbotsford, British Columbia, Canada
| | - S Miller
- University of British Columbia, British Columbia, Canada; BC Cancer - Prince George, Prince George, British Columbia, Canada
| | - S Atrchian
- University of British Columbia, British Columbia, Canada; BC Cancer - Kelowna, Kelowna, British Columbia, Canada
| | - E Chan
- University of British Columbia, British Columbia, Canada; BC Cancer - Kelowna, Kelowna, British Columbia, Canada
| | - C Ho
- University of British Columbia, British Columbia, Canada; BC Cancer - Surrey, Surrey, British Columbia, Canada
| | - I Mohamed
- University of British Columbia, British Columbia, Canada; BC Cancer - Kelowna, Kelowna, British Columbia, Canada
| | - A Lin
- University of British Columbia, British Columbia, Canada; BC Cancer - Kelowna, Kelowna, British Columbia, Canada
| | - V Huang
- BC Cancer - Surrey, Surrey, British Columbia, Canada
| | - A Mestrovic
- BC Cancer - Vancouver, Vancouver, British Columbia, Canada
| | - D Hyde
- University of British Columbia, British Columbia, Canada; BC Cancer - Kelowna, Kelowna, British Columbia, Canada
| | - C Lund
- University of British Columbia, British Columbia, Canada; BC Cancer - Surrey, Surrey, British Columbia, Canada
| | - H Pai
- University of British Columbia, British Columbia, Canada; BC Cancer - Victoria, Victoria, British Columbia, Canada
| | - B Valev
- University of British Columbia, British Columbia, Canada; BC Cancer - Victoria, Victoria, British Columbia, Canada
| | - S Lefresne
- University of British Columbia, British Columbia, Canada; BC Cancer - Vancouver, Vancouver, British Columbia, Canada
| | - S Tyldesley
- University of British Columbia, British Columbia, Canada; BC Cancer - Vancouver, Vancouver, British Columbia, Canada
| | - R Olson
- University of British Columbia, British Columbia, Canada; BC Cancer - Prince George, Prince George, British Columbia, Canada.
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Cruz-Lim EM, Mou B, Jiang W, Liu M, Bergman A, Schellenberg D, Alexander A, Berrang T, Bang A, Chng N, Matthews Q, Carolan H, Hsu F, Miller S, Atrchian S, Chan E, Ho C, Mohamed I, Lin A, Huang V, Mestrovic A, Hyde D, Lund C, Pai H, Valev B, Lefresne S, Tyldesley S, Olson R, Baker S. Predictors of Quality of Life Decline in Patients with Oligometastases treated with Stereotactic Ablative Radiotherapy: Analysis of the Population-Based SABR-5 Phase II Trial. Clin Oncol (R Coll Radiol) 2024; 36:141-147. [PMID: 38296662 DOI: 10.1016/j.clon.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 11/15/2023] [Accepted: 01/11/2024] [Indexed: 02/02/2024]
Abstract
AIMS Most patients experience stable quality of life (QoL) after stereotactic ablative radiotherapy (SABR) treatment for oligometastases. However, a subset of patients experience clinically relevant declines in QoL on post-treatment follow-up. This study aimed to identify risk factors for QoL decline. MATERIALS AND METHODS The SABR-5 trial was a population-based single-arm phase II study of SABR to up to five sites of oligometastases. Prospective QoL was measured using treatment site-specific tools at pre-treatment baseline and 3, 6, 9, 12, 15, 18, 21, 24, 30 and 36 months after treatment. The time to persistent QoL decline was calculated as the time from SABR to the first decline in QoL score meeting minimum clinically important difference with no improvement to baseline score on subsequent assessments. Univariable and multivariable logistic regression analyses were carried out to determine factors associated with QoL decline. RESULTS One hundred and thirty-three patients were included with a median follow-up of 32 months (interquartile range 25-43). Thirty-five patients (26%) experienced a persistent decline in QoL. The median time until persistent QoL decline was not reached. The cumulative incidence of QoL decline at 2 and 3 years were 22% (95% confidence interval 14.0-29.6) and 40% (95% confidence interval 28.0-51.2), respectively. In multivariable analysis, disease progression (odds ratio 5.23, 95% confidence interval 1.59-17.47, P = 0.007) and adrenal metastases (odds ratio 9.70, 95% confidence interval 1.41-66.93, P = 0.021) were associated with a higher risk of QoL decline. Grade 3 or higher (odds ratio 3.88, 95% confidence interval 0.92-16.31, P = 0.064) and grade 2 or higher SABR-associated toxicity (odds ratio 2.24, 95% confidence interval 0.85-5.91, P = 0.10) were associated with an increased risk of QoL decline but did not reach statistical significance. CONCLUSIONS Disease progression and adrenal lesion site were associated with persistent QoL decline following SABR. The development of grade 3 or higher toxicities was also associated with an increased risk, albeit not statistically significant. Further studies are needed, focusing on the QoL impact of metastasis-directed therapies.
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Affiliation(s)
- E M Cruz-Lim
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Kelowna, British Columbia, Canada
| | - B Mou
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Kelowna, British Columbia, Canada
| | - W Jiang
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Surrey, British Columbia, Canada
| | - M Liu
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Vancouver, British Columbia, Canada
| | - A Bergman
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Vancouver, British Columbia, Canada
| | - D Schellenberg
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Surrey, British Columbia, Canada
| | - A Alexander
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Victoria, British Columbia, Canada
| | - T Berrang
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Victoria, British Columbia, Canada
| | - A Bang
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Vancouver, British Columbia, Canada
| | - N Chng
- BC Cancer - Prince George, British Columbia, Canada
| | - Q Matthews
- BC Cancer - Prince George, British Columbia, Canada
| | - H Carolan
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Vancouver, British Columbia, Canada
| | - F Hsu
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Abbotsford, British Columbia, Canada
| | - S Miller
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Prince George, British Columbia, Canada
| | - S Atrchian
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Kelowna, British Columbia, Canada
| | - E Chan
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Vancouver, British Columbia, Canada
| | - C Ho
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Surrey, British Columbia, Canada
| | - I Mohamed
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Kelowna, British Columbia, Canada
| | - A Lin
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Kelowna, British Columbia, Canada
| | - V Huang
- BC Cancer - Surrey, British Columbia, Canada
| | - A Mestrovic
- BC Cancer - Vancouver, British Columbia, Canada
| | - D Hyde
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Kelowna, British Columbia, Canada
| | - C Lund
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Surrey, British Columbia, Canada
| | - H Pai
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Victoria, British Columbia, Canada
| | - B Valev
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Victoria, British Columbia, Canada
| | - S Lefresne
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Vancouver, British Columbia, Canada
| | - S Tyldesley
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Vancouver, British Columbia, Canada
| | - R Olson
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Prince George, British Columbia, Canada
| | - S Baker
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Surrey, British Columbia, Canada.
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Cruz-Lim EM, Mou B, Baker S, Arbour G, Stefanyk K, Jiang W, Liu M, Bergman A, Schellenberg D, Alexander AS, Berrang T, Bang A, Chng N, Matthews Q, Tyldesley S, Olson RA. Prospective Longitudinal Assessment of Quality of Life after Stereotactic Ablative Radiotherapy for Oligometastases: Analysis of the Population-Based SABR-5 Phase II Trial. Int J Radiat Oncol Biol Phys 2023; 117:e224-e225. [PMID: 37784911 DOI: 10.1016/j.ijrobp.2023.06.1131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) To evaluate longitudinal patient-reported quality of life (QoL) in patients treated with stereotactic ablative radiotherapy (SABR) for oligometastases. MATERIALS/METHODS The SABR-5 trial was a population-based single-arm phase II study of SABR to up to 5 sites of oligometastases, conducted in 6 regional cancer centers in British Columbia from 2016 to 2020. Prospective QoL was measured using treatment site-specific QoL questionnaires at pre-treatment baseline and 3, 6, 9, 12, 15, 18, 21, 24, 30, and 36 months after treatment. Patients with bone metastases were assessed with the Brief Pain Inventory (BPI). Patients with liver, adrenal, and abdominopelvic lymph node metastases were assessed with the Functional Assessment of Chronic Illness Therapy-Abdominal Discomfort (FACIT-AD). Patients with lung and intrathoracic lymph node metastases were assessed with the Prospective Outcomes and Support Initiative (POSI) lung questionnaire. The two one-sided test procedure was used to assess equivalence between the worst QoL score and baseline score of individual patients. Mean QoL at all time points was used to determine the trajectory of QoL response after SABR. The proportion of patients with "stable," "improved," or "worsened" QoL was determined for all time points based on standard minimal clinically important differences (MCID; BPI worst pain = 2, BPI Functional Interference Score [FIS] = 0.5, FACIT-AD Trial Outcome Index [TOI] = 8, POSI = 3). RESULTS All enrolled patients with baseline QoL assessment and at least 1 follow-up assessment were analyzed (n = 135). On equivalence testing, patients' worst QoL scores were clinically different from baseline scores and met MCID (BPI worst pain mean difference: 1.8, 90% CI [1.19 to 2.42]; BPI FIS mean difference: 1.68, 90% CI [1.15 to 2.21]; FACIT-AD TOI mean difference: -8.76, 90% CI [-11.29 to -6.24]; POSI mean difference: -4.61, 90% CI [-6.09 to -3.14]). However, the mean FIS transiently worsened at 9, 18 and 21 months but eventually returned to stable levels. The mean FACIT and POSI scores also worsened at 36 months, albeit with a limited number of responses (n = 4 and 8, respectively). The majority of patients reported stable QoL at all time points (range: BPI worst pain 71-82%, BPI FIS 45-78%, FACIT-AD TOI 50-100%, POSI 25-73%). Clinically significant stability, worsening, and improvement were seen in 70%/13%/18% of patients at 3 months, 53%/28%/19% at 18 months and 63%/25%/13% at 36 months. CONCLUSION SABR in the oligometastatic setting can lead to transient decreases in QoL. However, most patients experienced stable QoL relative to pre-treatment levels on long-term follow-up. Further studies are needed to characterize patients at greatest risk for decreased QoL.
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Affiliation(s)
- E M Cruz-Lim
- University of British Columbia, Vancouver, BC, Canada; BC Cancer Kelowna, Kelowna, BC, Canada
| | - B Mou
- University of British Columbia, Vancouver, BC, Canada; BC Cancer Kelowna, Kelowna, BC, Canada
| | - S Baker
- University of British Columbia, Vancouver, BC, Canada; BC Cancer - Surrey, Surrey, BC, Canada
| | - G Arbour
- University of British Columbia, Vancouver, BC, Canada
| | - K Stefanyk
- University of British Columbia, Vancouver, BC, Canada
| | - W Jiang
- University of British Columbia, Vancouver, BC, Canada; BC Cancer - Surrey, Surrey, BC, Canada
| | - M Liu
- University of British Columbia, Vancouver, BC, Canada; BC Cancer Vancouver, Vancouver, BC, Canada
| | - A Bergman
- University of British Columbia, Vancouver, BC, Canada; BC Cancer Vancouver, Vancouver, BC, Canada
| | - D Schellenberg
- University of British Columbia, Vancouver, BC, Canada; BC Cancer - Surrey, Surrey, BC, Canada
| | - A S Alexander
- University of British Columbia, Vancouver, BC, Canada; BC Cancer Victoria, Victoria, BC, Canada
| | - T Berrang
- University of British Columbia, Vancouver, BC, Canada; BC Cancer Victoria, Victoria, BC, Canada
| | - A Bang
- University of British Columbia, Vancouver, BC, Canada; BC Cancer Vancouver, Vancouver, BC, Canada
| | - N Chng
- BC Cancer - Prince George, Prince George, BC, Canada
| | - Q Matthews
- BC Cancer - Prince George, Prince George, BC, Canada
| | - S Tyldesley
- University of British Columbia, Vancouver, BC, Canada; BC Cancer Vancouver, Vancouver, BC, Canada
| | - R A Olson
- University of British Columbia, Vancouver, BC, Canada; BC Cancer - Prince George, Prince George, BC, Canada
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Jiang W, Baker S, Liu M, Bergman A, Schellenberg D, Mou B, Alexander A, Carolan H, Atrchian S, Chan E, Mohamed I, Berrang T, Bang A, Chng N, Matthews Q, Pai H, Lefresne S, Tyldesley S, Olson R. Population Based Phase II Trial of Stereotactic Ablative Radiotherapy (SABR): Overall Survival Results of the SABR-5 Trial. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Baker S, Mou B, Jiang W, Liu M, Bergman A, Schellenberg D, Alexander A, Carolan H, Atrchian S, Berrang T, Bang A, Chng N, Matthews Q, Tyldesley S, Olson R. Validation of the Prognostic Utility of ESTRO/EORTC Oligometastatic Disease Classification: A Secondary Analysis from the Population-Based Phase II SABR-5 Trial. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Baker S, Mou B, Jiang W, Liu M, Bergman A, Schellenberg D, Alexander A, Carolan H, Atrchian S, Berrang T, Bang A, Chng N, Matthews Q, Tyldesley S, Olson R. Predictors of Early Polymetastatic Relapse Following Stereotactic Ablative Radiotherapy for up to 5 Oligometastases: A Secondary Analysis of the Phase II SABR-5 Trial. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Baker S, Mou B, Jiang W, Liu M, Bergman AM, Schellenberg D, Alexander AS, Carolan H, Atrchian S, Berrang T, Bang A, Chng N, Matthews Q, Tyldesley S, Olson RA. Predictors of early polymetastatic relapse following stereotactic ablative radiotherapy for up to 5 oligometastases: a secondary analysis of the phase II SABR-5 trial. Int J Radiat Oncol Biol Phys 2022; 114:856-861. [PMID: 35840110 DOI: 10.1016/j.ijrobp.2022.06.094] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 05/24/2022] [Accepted: 06/26/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE A subset of patients with oligometastatic cancer experience early widespread cancer dissemination and do not benefit from metastasis-directed therapy such as stereotactic ablative radiotherapy (SABR). This study aimed to identify factors associated with early polymetastatic relapse (PMR). METHODS AND MATERIALS The XXX trial was a single arm phase II study conducted at all 6 regional cancer centres across XXX. SABR for oligometastases was only offered on trial. Patients with up to 5 oligometastatic lesions (total, progressing or induced) received SABR to all lesions. Patients were 18 years of age or older, ECOG 0-2 and life expectancy ≥ 6 months. This secondary analysis evaluated factors associated with early PMR, defined as disease recurrence within 6 months of SABR which is not amenable to further local treatment. Univariable and multivariable analyses were performed using binary logistic regression. The Kaplan Meier method and log-rank tests assessed PMR-free survival and differences between risk groups, respectively. RESULTS Between November 2016 and July 2020, 381 patients underwent treatment on XXX. A total of 16% of patients experienced PMR. Worse performance status (ECOG 1-2 vs 0; HR=2.01, p=0.018), non-prostate/breast histology (HR=3.64, p<0.001) and oligoprogression (HR=3.84, p<0.001) were independent predictors for early PMR. Risk groups were identified with median PMR-free survival ranging from 5 months to not yet reached at the time of analysis. Rates of 3-year OS were 0%, 53% (95% confidence interval [CI] 48 - 58), 77% (95% CI 73 - 81) and 93% (95% CI 90 - 96) in groups 1-4, respectively (p<0.001). CONCLUSION Four distinct risk groups for early PMR are identified, which differ significantly in PMR-free survival and overall survival. The group with all three risk factors had a median PMR-free survival of 5 months and may not benefit from local ablative therapy alone. This model should be externally validated with data from other prospective trials.
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Affiliation(s)
- S Baker
- University of British Columbia; BC Cancer, Surrey.
| | - B Mou
- University of British Columbia; BC Cancer, Kelowna
| | - W Jiang
- University of British Columbia; BC Cancer, Surrey
| | - M Liu
- University of British Columbia; BC Cancer, Vancouver
| | | | | | | | - H Carolan
- University of British Columbia; BC Cancer, Vancouver
| | - S Atrchian
- University of British Columbia; BC Cancer, Kelowna
| | - T Berrang
- University of British Columbia; BC Cancer, Victoria
| | - A Bang
- University of British Columbia; BC Cancer, Victoria
| | | | | | - S Tyldesley
- University of British Columbia; BC Cancer, Vancouver
| | - R A Olson
- University of British Columbia; BC Cancer, Prince George.
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Qian J, Akama-Garren E, Shin J, Bang A, Pike L, Grassberger C, Schoenfeld J. Dosimetric Factors Associated With Lymphopenia in Metastatic Cancer Patients Receiving Palliative Radiation and PD-1 Immune Checkpoint Inhibitors. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.1315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Olson R, Jiang W, Liu M, Bergman A, Schellenberg D, Mou B, Alexander A, Carolan H, Hsu F, Miller S, Atrchian S, Chan E, Ho C, Mohamed I, Lin A, Berrang T, Bang A, Chng N, Matthews Q, Huang V, Mestrovic T, Hyde D, Lund C, Pai H, Valev B, Lefresne S, Tyldesley S. Population Based Phase II Trial of Stereotactic Ablative Radiotherapy (SABR) for up to 5 Oligometastases: Preliminary Results of the SABR-5 Trial. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Fife K, Bang A. Combined Radiotherapy and New Systemic Therapies - Have We Moved Beyond Palliation? Clin Oncol (R Coll Radiol) 2020; 32:758-765. [PMID: 32863071 DOI: 10.1016/j.clon.2020.07.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 07/23/2020] [Accepted: 07/30/2020] [Indexed: 12/12/2022]
Abstract
The new systemic therapies for cancer are having major impacts on the prognosis of patients with advanced cancers, some achieving long-term survival with targeted therapy or immune checkpoint inhibitors. Interactions of radiotherapy with the new systemic therapies are reviewed. Many agents increase radiosensitivity and particular caution is required combining BRAF inhibitors and radiotherapy because of significant toxicity. Most new systemic therapies can be used safely with palliative doses of radiotherapy, but it is important to be aware of overlapping toxicities depending on the site treated. DNA damage response modulators increase radiosensitivity and may potentially increase radiation toxicity but are at an earlier stage of development. Stereotactic ablative radiotherapy may produce further survival gains in patients responding to targeted therapy and immunotherapy.
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Affiliation(s)
- K Fife
- Oncology Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
| | - A Bang
- Division of Radiation Oncology, University of British Columbia/BC Cancer, Victoria, British Columbia, Canada
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Bang A, Mahmood U, Chen Y, Mak R, Lorch J, Hanna G, Sridharan V, Busse P, Willers H, Mamon H, Yoo H, Pai S, Wirth L, Haddad R, Chau N, Schoenfeld J. Local Control following Combination Hypofractionated Radiotherapy and Pembrolizumab in A Phase II Trial of Recurrent or Metastatic Adenoid Cystic Carcinoma Patients. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Toh T, Bang A, Pinto D, Katrina H, Brown C, Xu W, Liu G, Lok B. PO-0774 Outcomes of IMRT/VMAT vs 2D/3D-conformal thoracic radiation in limited stage small-cell lung cancer. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31194-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Fareed M, Pike L, Bang A, Taylor A, Spektor A, Awad M, Ott P, Krishnan M, Balboni T, Schoenfeld J. Palliative Radiation Therapy for Vertebral Metastases and Metastatic Cord Compression in Patients Treated with Anti-PD-1 Therapy. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Pike L, Bang A, Taylor A, Krishnan M, Spektor A, Cagney D, Aizer A, Alexander B, Rahma O, Balboni T, Ott P, Hodi F, Schoenfeld J. Impact of Palliative Radiation on Lymphocyte Count and Neutrophil-to-Lymphocyte Ratio in Patients Receiving PD-1 Inhibitors. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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15
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Hasan M, Bang A, Lechtman E, Atenafu E, Sun A, Bissonnette J. Quantifying Upstage Rate as a Function of Delay from Diagnostic Imaging for Locally-Advanced Lung Cancer Patients. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.1844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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16
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Cole-Clark D, Nair-Shalliker V, Bang A, Rasiah K, Chalasani V, Smith DP. An initial melanoma diagnosis may increase the subsequent risk of prostate cancer: Results from the New South Wales Cancer Registry. Sci Rep 2018; 8:7167. [PMID: 29740153 PMCID: PMC5940665 DOI: 10.1038/s41598-018-25408-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 04/10/2018] [Indexed: 12/18/2022] Open
Abstract
Emerging evidence suggests that a diagnosis of cutaneous melanoma (CM) may be associated with prostate cancer (PC) incidence. We examined if the incidence of CM was associated with an increased subsequent risk of PC. We used data from the New South Wales Cancer Registry for all CM and PC cases diagnosed between January 1972 and December 2008. We calculated the age standardized incidence ratio (SIR) and 95% confidence intervals (95% CI) for PC incidence following a CM diagnosis, applying age- and calendar- specific rates to the appropriate person years at risk. We determined rate ratio (RR) and 95% CI of PC incidence according to specified socio-demographic categories and disease related characteristics, using a negative binomial model. There were 143,594 men diagnosed with PC or CM in the study period and of these 101,198 and 42,396 were diagnosed with PC and CM, respectively, as first primary cancers. Risk of PC incidence increased following CM diagnosis (n = 2,114; SIR = 1.25; 95% CI:1.20.8-1.31: p < 0.0001), with the increased risk apparent in men diagnosed with localised CM (n = 1,862;SIR = 1.26; 95% CI:1.20-1.32). CM diagnosis increased the subsequent risk of PC incidence. This raises the potential for future PC risk to be discussed with newly diagnosed males with CM.
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Affiliation(s)
- D Cole-Clark
- Department of Surgery, Royal North Shore Hospital, New South Wales, Australia
| | - V Nair-Shalliker
- Cancer Research Division, Cancer Council NSW, Sydney, NSW, Australia.
- Sydney School of Public Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.
| | - A Bang
- Cancer Research Division, Cancer Council NSW, Sydney, NSW, Australia
| | - K Rasiah
- Northern Sydney Local Health District, New South Wales, Australia
- Garvan Institute of Medical Research & Kinghorn Cancer Centre, New South Wales, Australia
| | - V Chalasani
- Garvan Institute of Medical Research & Kinghorn Cancer Centre, New South Wales, Australia
- Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group, Discipline of Surgery, University of Sydney, New South Wales, Australia
| | - D P Smith
- Cancer Research Division, Cancer Council NSW, Sydney, NSW, Australia
- Sydney School of Public Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
- Menzies Health Institute, Queensland, Griffith University, Gold Coast, Queensland, Australia
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Abstract
To assess the involvement of hospitals in geriatric, community and long-term care services, a survey was undertaken of the 104 acute care hospitals in Massachusetts. Results show that hospitals (N = 81) are adding geriatric expertise but as yet have taken on community services and long-term care only to a small extent. Hospitals perceive major deficiencies in physician service to nursing homes (89 per cent) and in availability of inpatient geriatric units (94 per cent). Responding hospitals have targeted for development by 1985 geriatric inpatient units (17 per cent), respite care (16 per cent), and hospice care (16 per cent). The financial implications of the survey results are discussed with respect to prospective reimbursement and public health implications.
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Feletto E, Bang A, Cole-Clark D, Chalasani V, Rasiah K, Smith DP. An examination of prostate cancer trends in Australia, England, Canada and USA: Is the Australian death rate too high? World J Urol 2015; 33:1677-87. [PMID: 25698456 PMCID: PMC4617845 DOI: 10.1007/s00345-015-1514-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 01/23/2015] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To compare prostate cancer incidence and mortality rates in Australia, USA, Canada and England and quantify the gap between observed prostate cancer deaths in Australia and expected deaths, using US mortality rates. METHODS Analysis of age-standardised prostate cancer incidence and mortality rates, using routinely available data, in four similarly developed countries and joinpoint regression to quantify the changing rates (annual percentage change: APC) and test statistical significance. Expected prostate cancer deaths, using US mortality rates, were calculated and compared with observed deaths in Australia (1994-2010). RESULTS In all four countries, incidence rates initially peaked between 1992 and 1994, but a second, higher peak occurred in Australia in 2009 (188.9/100,000), rising at a rate of 5.8 % (1998-2008). Mortality rates in the USA (APC: -2.9 %; 2004-2010), Canada (APC: -2.9 %; 2006-2011) and England (APC: -2.6 %; 2003-2008) decreased at a faster rate compared with Australia (APC: -1.7 %; 1997-2011). In 2010, mortality rates were highest in England and Australia (23.8/100,000 in both countries). The mortality gap between Australia and USA grew from 1994 to 2010, with a total of 10,895 excess prostate cancer deaths in Australia compared with US rates over 17 preceding years. CONCLUSIONS Prostate cancer incidence rates are likely heavily influenced by prostate-specific antigen testing, but the fall in mortality occurred too soon to be solely a result of testing. Greater emphasis should be placed on addressing system-wide differences in the management of prostate cancer to reduce the number of men dying from this disease.
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Affiliation(s)
- E Feletto
- Cancer Research Division, Cancer Council NSW, Woolloomooloo, NSW, Australia.
| | - A Bang
- Cancer Research Division, Cancer Council NSW, Woolloomooloo, NSW, Australia.
| | - D Cole-Clark
- Department of Surgery, Royal North Shore Hospital, St Leonards, NSW, Australia.
| | - V Chalasani
- Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group, Discipline of Surgery, University of Sydney, Camperdown, NSW, Australia. .,Northern Sydney Local Health District, St Leonards, NSW, Australia.
| | - K Rasiah
- Northern Sydney Local Health District, St Leonards, NSW, Australia. .,Kinghorn Cancer Centre, Garvan Institute of Medical Research, St Leonards, NSW, Australia.
| | - D P Smith
- Cancer Research Division, Cancer Council NSW, Woolloomooloo, NSW, Australia. .,Griffith Health Institute, Griffith University, Nathan, QLD, Australia.
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Teoh H, Quan A, Creighton A, Bang A, Shukla P, Singh K, Gupta N, Pan Y, Lovren F, Leong-Poi H, Al-Omran M, Verma S. 113 Gene therapy with brca1 reduces systemic inflammatory response and multiple organ failure and improves survival in experimental sepsis. Can J Cardiol 2011. [DOI: 10.1016/j.cjca.2011.07.277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Weber RE, Fago A, Val AL, Bang A, Van Hauwaert ML, Dewilde S, Zal F, Moens L. Isohemoglobin differentiation in the bimodal-breathing amazon catfish Hoplosternum littorale. J Biol Chem 2000; 275:17297-305. [PMID: 10747999 DOI: 10.1074/jbc.m001209200] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The bimodal gill(water)/gut(air)-breathing Amazonian catfish Hoplosternum littorale that frequents hypoxic habitats uses "mammalian" 2,3-diphosphoglycerate (DPG) in addition to "piscine" ATP and GTP as erythrocytic O(2) affinity modulators. Its electrophoretically distinct anodic and cathodic hemoglobins (Hb(An) and Hb(Ca)) were isolated for functional and molecular characterization. In contrast to Hb(An), phosphate-free Hb(Ca) exhibits a pronounced reverse Bohr effect (increased O(2) affinity with decreasing pH) that is obliterated by ATP, and opposite pH dependences of K(T) (O(2) association constant of low affinity, tense state) and the overall heat of oxygenation. Dose-response curves indicate small chloride effects and pronounced and differentiated phosphate effects, DPG < ATP < GTP < IHP. Hb(Ca)-O(2) equilibria analyzed in terms of the Monod-Wyman-Changeux model show that small T state bond energy differences underlie the differentiated phosphate effects. Synthetic peptides, corresponding to N-terminal fragment of the cytoplasmic domain of trout band 3 protein, undergo oxygenation-linked binding to Hb(Ca), suggesting a metabolic regulatory role for this hemoglobin. The amino acid sequences for the alpha and beta chains of Hb(Ca) obtained by Edman degradation and cDNA sequencing show unusual substitutions at the phosphate-binding site that are discussed in terms of its reverse Bohr effect and anion sensitivities.
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Affiliation(s)
- R E Weber
- Department of Zoophysiology, University of Aarhus, DK 8000 Aarhus C, Denmark.
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Abstract
Overexpression of XOptx2, a homeodomain-containing transcription factor expressed in the Xenopus embryonic eye field, results in a dramatic increase in eye size. An XOptx2-Engrailed repressor gives a similar phenotype, while an XOptx2-VP16 activator reduces eye size. XOptx2 stimulates bromodeoxyuridine incorporation, and XOptx2-induced eye enlargement is dependent on cellular proliferation. Moreover, retinoblasts transfected with XOptx2 produce clones of cells approximately twice as large as control clones. Pax6, which does not increase eye size alone, acts synergistically with XOptx2. Our results suggest that XOptx2, in combination with other genes expressed in the eye field, is crucially involved in the proliferative state of retinoblasts and thereby the size of the eye.
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Affiliation(s)
- M E Zuber
- Department of Anatomy, University of Cambridge, United Kingdom
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Herlitz J, Ekstrom L, Wennerblom B, Axelsson A, Bang A, Holmberg S. Type of arrhythmia at EMS arrival on scene in out-of-hospital cardiac arrest in relation to interval from collapse and whether a bystander initiated CPR. Resuscitation 1996. [DOI: 10.1016/0300-9572(96)89041-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bang A, Speck ER, Blanchette VS, Freedman J, Semple JW. Recipient humoral immunity against leukoreduced allogeneic platelets is suppressed by aminoguanidine, a selective inhibitor of inducible nitric oxide synthase. Blood 1996; 88:2959-66. [PMID: 8874192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Leukoreduced allogeneic platelet transfusions have been previously shown to initially stimulate an in vitro cellular cytotoxicity and subsequently Induce the formation of immunoglobulin G (IgG) antidonor alloantibodies. To further characterize these responses and determine if they are related, recipient BALB/c H-2d mice were treated with aminoguanidine (AMG), a selective inhibitor of inducible nitric oxide synthase (iNOS), and transfused weekly with 2 x 10(8) C57BL/6 H2b platelets. In control, non-AMG-treated mice, transfusion significantly (P < .01) increased serum levels of interferon-gamma (IFN-gamma) by day 1 posttransfusion (PT). IFN-gamma returned to pretransfusion levels by day 3 PT, and its production was not affected by AMG treatment. Serum interleukin-4 (IL-4), on the other hand, was undetectable before and during the transfusion protocol. By day 3 PT, recipient spleen cells could mediate in vitro anti-P815 (auto), anti-EL4 (allo), and anti-R1.1 (third-party MHC) cytotoxicity, and these responses were maximal by day 7 PT. Concurrently, a significant reduction in the vitro ability of recipient splenocytes to respond to Concanavalin A (ConA) was observed; this was not seen with lipopolysaccharide (LPS) stimulation. Elevated levels of NO2- were found in the ConA culture supernatants from transfused mice at day 3 PT. Serum antidonor alloantibodies were detected by the fifth platelet transfusion. AMG treatment of recipient mice significantly inhibited the transfusion. Induced cytotoxicity and ConA-stimulated NO2- production, and restored ConA-induced proliferation to normal levels. AMG appeared to selectively inhibit platelet-induced alloantibody production in that it did not affect antibody production induced by transfusions with 10(5) allogeneic leukocytes or by immunization with a foreign protein antigen, human gamma globulin, in adjuvant therapy. These results indicate that an in vivo AMG-sensitive mechanism is essential for recipients to initiate a humoral IgG immune response against allogeneic platelets.
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Affiliation(s)
- A Bang
- Division of Hematology, St Michael's Hospital, Toronto, Ontario, Canada
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Bang A, Bang R. Action re-SEARCH with people: exploring new horizons of primary health care. Health Millions 1995; 21:54-62. [PMID: 12290962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
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Herlitz J, Ekstrom L, Wennerblom B, Axelsson A, Bang A, Holmberg S. Risk indicators for, and symptoms associated with, death among patients hospitalized after out-of-hospital cardiac arrest. Resuscitation 1995. [DOI: 10.1016/0300-9572(95)99669-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Affiliation(s)
- A Bang
- SEARCH, Gandchoroli, India
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Bang A. Victory of the people's movement against alcohol in Gadchiroli. Natl Med J India 1992; 5:251-2. [PMID: 1302594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Bang A. Masking the readers may ensure objective judgment about clinical trials. Control Clin Trials 1991; 12:553-5. [PMID: 1657530 DOI: 10.1016/0197-2456(91)90014-d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Bang R, Bang A. Commentary on a community-based approach to reproductive health care. Society for Education, Action and Research in Community Health Team. Suppl Int J Gynecol Obstet 1989; 3:125-9. [PMID: 2590475 DOI: 10.1016/0020-7292(89)90112-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Reproductive care needs to be broadened beyond maternity care and family planning to include care for gynecological and sexual problems, safe abortion services, and sex and reproductive health education. Our epidemiologic study of rural women has shown a very high prevalence of gynecological diseases. We tried to develop a community-based approach to comprehensive reproductive care by undertaking participatory research, fostering mass education with the people's involvement, and by making care available through village-based female workers and improved referral services. We end with two appeals: "MCH" needs to be replaced by WCH: not merely Maternal and Child Health but Woman and Child Health. Care should be provided through a community-based participatory approach, not through narrow technocratic vertical programs. Let people shape their own lives!
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