1
|
Greene AC, Ziegler O, Pameijer CR, Shen C. ASO Author Reflections: Exploring the Impact-Medicaid Expansion and Improved Survival in Patients with Cutaneous Melanoma. Ann Surg Oncol 2024:10.1245/s10434-024-15286-w. [PMID: 38647911 DOI: 10.1245/s10434-024-15286-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 03/26/2024] [Indexed: 04/25/2024]
Affiliation(s)
- Alicia C Greene
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, USA
| | - Olivia Ziegler
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, USA
| | - Colette R Pameijer
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, USA
| | - Chan Shen
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, USA.
| |
Collapse
|
2
|
Fan XK, Li MY, Qin Y, Shen C, Lu Y, Sun ZM, Yang J, Tao R, Zhou JY, Hang D, Su J. [Associations of onset age, diabetes duration and glycated hemoglobin level with ischemic stroke risk in type 2 diabetes patients: a prospective cohort study]. Zhonghua Liu Xing Bing Xue Za Zhi 2024; 45:498-505. [PMID: 38678344 DOI: 10.3760/cma.j.cn112338-20231009-00210] [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] [Grants] [Subscribe] [Scholar Register] [Indexed: 04/29/2024]
Abstract
Objective: To investigate the associations of onset age, diabetes duration, and glycated hemoglobin (HbA1c) levels with ischemic stroke risk in type 2 diabetes patients. Methods: The participants were from Comprehensive Research on the Prevention and Control of the Diabetes in Jiangsu Province. The study used data from baseline survey from December 2013 to January 2014 and follow-up until December 31, 2021. After excluding the participants who had been diagnosed with stroke at baseline survey and those with incomplete information on onset age, diabetes duration, and HbA1c level, a total of 17 576 type 2 diabetes patients were included. Cox proportional hazard model was used to calculate the hazard ratio (HR) and 95%CI of onset age, diabetes duration, and HbA1c level for ischemic stroke. Results: During the median follow-up time of 8.02 years, 2 622 ischemic stroke cases were registered. Multivariate Cox proportional risk regression model showed that a 5-year increase in type 2 diabetes onset age was significantly associated with a 5% decreased risk for ischemic stroke (HR=0.95, 95%CI: 0.92-0.99). A 5-year increase in diabetes duration was associated with a 5% increased risk for ischemic stroke (HR=1.05, 95%CI: 1.02-1.10). Higher HbA1c (per 1 standard deviation increase:HR=1.17, 95%CI: 1.13-1.21) was associated with an increased risk for ischemic stroke. Conclusion: The earlier onset age of diabetes, longer diabetes duration, and high levels of HbA1c are associated with an increased risk for ischemic stroke in type 2 diabetes patients.
Collapse
Affiliation(s)
- X K Fan
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China
| | - M Y Li
- School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Y Qin
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China
| | - C Shen
- School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Y Lu
- Suzhou Prefectural Center for Disease Control and Prevention, Suzhou 215003, China
| | - Z M Sun
- Huai'an Prefectural Center for Disease Control and Prevention, Huai'an 223001, China
| | - J Yang
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - R Tao
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - J Y Zhou
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - D Hang
- School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - J Su
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China School of Public Health, Nanjing Medical University, Nanjing 211166, China
| |
Collapse
|
3
|
Kang DW, Wang L, Short NJ, Ferrajoli A, Wang Y, Zhou S, Shen C. Cost Effectiveness of Zanubrutinib Versus Ibrutinib in Relapsed or Refractory Chronic Lymphocytic Leukemia. Pharmacoeconomics 2024; 42:409-418. [PMID: 38184494 DOI: 10.1007/s40273-023-01346-8] [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] [Subscribe] [Scholar Register] [Accepted: 12/11/2023] [Indexed: 01/08/2024]
Abstract
BACKGROUND While the efficacy and safety of zanubrutinib have been established in relapsed or refractory chronic lymphocytic leukemia, the evidence on cost effectiveness is still lacking. OBJECTIVE We aimed to evaluate the cost effectiveness of zanubrutinib versus ibrutinib in relapsed or refractory chronic lymphocytic leukemia from the commercial payer perspective in the USA. METHODS A partitioned survival model was developed based on survival curves from the phase III ALPINE trial. We reconstructed patient-level data for each curve and conducted a parametric estimation to incorporate long-term clinical outcomes and treatment costs into the model. Medical costs and utilities were obtained from public data and previous cost-effectiveness studies. A discount rate of 3.0% per annum was applied and costs were adjusted to 2023 US dollars. The incremental cost-effectiveness ratio was calculated by dividing the incremental costs of zanubrutinib over ibrutinib by the incremental life-years or quality-adjusted life-years. Deterministic and probabilistic sensitivity analyses were performed to examine the robustness of the results. RESULTS Over a 10-year analysis period, the incremental cost-effectiveness ratio of zanubrutinib versus ibrutinib was $91,260 per life-year gained and $120,634 per quality-adjusted life-year gained, making it cost effective within a threshold of $150,000 per quality-adjusted life-year gained. The incremental cost-effectiveness ratio was most sensitive to drug acquisition costs and progression-free survival distributions, and the probability of zanubrutinib being cost effective was approximately 52.8%, with a 30.0% likelihood of dominance. CONCLUSIONS Zanubrutinib is likely to be cost effective versus ibrutinib in relapsed or refractory chronic lymphocytic leukemia in the USA, but the high threshold should be noted. Our findings may provide a basis for pricing strategy and reimbursement decisions for zanubrutinib.
Collapse
Affiliation(s)
- Dong-Won Kang
- Department of Surgery, Penn State College of Medicine, The Pennsylvania State University, 500 University Drive, H151, Hershey, PA, 17033-0850, USA
| | - Li Wang
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Nicholas J Short
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Alessandra Ferrajoli
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yucai Wang
- Department of Hematology, Mayo Clinic College of Medicine, Rochester, MI, USA
| | - Shouhao Zhou
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Chan Shen
- Department of Surgery, Penn State College of Medicine, The Pennsylvania State University, 500 University Drive, H151, Hershey, PA, 17033-0850, USA.
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA.
| |
Collapse
|
4
|
Song MF, Ma LY, Shen C, Zhao Q, Zhao CY. [Liver cancer treatment with mitochondrial homeostasis]. Zhonghua Gan Zang Bing Za Zhi 2024; 32:257-261. [PMID: 38584111 DOI: 10.3760/cma.j.cn501113-20231107-00175] [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] [Grants] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
Systemic treatment, including molecular targeted therapy, immunotherapy, and chemotherapy, is an important means of achieving long-term survival in patients with intermediate-and advanced-stage liver cancer. However, some patients are insensitive to treatment and even develop drug resistance. Mitochondria are the center of cellular energy metabolism and, at the same time, are the priority targets for systemic therapy. Mitochondrial homeostasis plays an important role in the treatment of liver cancer. The relationship between the two advances is elucidated so as to provide better ideas for the clinical treatment of liver cancer.
Collapse
Affiliation(s)
- M F Song
- Department of Infectious Disease, the Third Hospital of Hebei Medical University, Shijiazhuang 050051, China
| | - L Y Ma
- Department of Infectious Disease, the Third Hospital of Hebei Medical University, Shijiazhuang 050051, China
| | - C Shen
- Department of Infectious Disease, the Third Hospital of Hebei Medical University, Shijiazhuang 050051, China
| | - Q Zhao
- Quality Management and Control Office, the Third Hospital of Hebei Medical University, Shijiazhuang 050051, China
| | - C Y Zhao
- Department of Infectious Disease, the Third Hospital of Hebei Medical University, Shijiazhuang 050051, China
| |
Collapse
|
5
|
Thornton JD, Varisco T, Prachet B, Olateju O, Shrestha M, Shen C. Productivity Loss Among Opioid and Benzodiazepine Users in the United States: A Medical Expenditure Panel Survey From 2010 to 2019. J Occup Environ Med 2024; 66:226-233. [PMID: 38151973 PMCID: PMC10922134 DOI: 10.1097/jom.0000000000003029] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
OBJECTIVE The aim of the study is to estimate the association between productivity losses and the use of prescription opioids and benzodiazepines among employed US adults with painful conditions. METHODS Using Medical Expenditures Panel Survey (2010-2019), we used two-part (logistic regression and generalized linear model with zero-truncated negative binomial link) model to compare missed workdays due to illness or injury among employed adults with a painful condition. RESULTS Of the eligible sample of 57,413 working US individuals, 14.65% were prescription opioid users, 2.95% were benzodiazepine users, and 1.59% were both opioid and benzodiazepine users. The predicted missed workdays were 5.75 (95% Confidence Limit [CL]: 5.58-5.92) days for benzodiazepine users, 13.06 (95% CL: 12.88-13.23) days among opioid users, and 15.18 (95% CL: 14.46-15.90) days for opioid and benzodiazepine concomitant users. CONCLUSIONS Concomitant use of prescription opioids and benzodiazepines was significantly associated with having more missed workdays among employed adults with documented painful conditions.
Collapse
Affiliation(s)
- J. Douglas Thornton
- Prescription Drug Misuse Education and Research Center, College of Pharmacy, University of Houston, Houston, Texas, USA
- Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, Houston, Texas, USA
| | - Tyler Varisco
- Prescription Drug Misuse Education and Research Center, College of Pharmacy, University of Houston, Houston, Texas, USA
- Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, Houston, Texas, USA
| | - Bhatt Prachet
- Prescription Drug Misuse Education and Research Center, College of Pharmacy, University of Houston, Houston, Texas, USA
- Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, Houston, Texas, USA
| | - Olajumoke Olateju
- Prescription Drug Misuse Education and Research Center, College of Pharmacy, University of Houston, Houston, Texas, USA
- Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, Houston, Texas, USA
| | - Mina Shrestha
- Prescription Drug Misuse Education and Research Center, College of Pharmacy, University of Houston, Houston, Texas, USA
- Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, Houston, Texas, USA
| | - Chan Shen
- Division of Outcomes Research and Quality, College of Medicine, Pennsylvania State University, Hershey, PA, USA
| |
Collapse
|
6
|
Segel JE, Wong WG, Kaag M, Joshi M, Warrick J, Lengerich EJ, Shen C. Relationship Between Availability of Urologists and Primary Care Providers and Stage of Diagnosis for Invasive Urinary Bladder Cancer. Urol Pract 2024; 11:339-346. [PMID: 38305777 DOI: 10.1097/upj.0000000000000503] [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: 08/16/2023] [Accepted: 11/13/2023] [Indexed: 02/03/2024]
Abstract
INTRODUCTION With no recommended screening approach, urinary bladder cancer patients rely on referral to urologists to ensure timely diagnosis of bladder cancer. This requires coordination between primary and specialty care. We provide estimates of the relative association between primary care physician and urologist density on stage of urinary bladder cancer diagnosis. METHODS We used 2010 to 2016 Pennsylvania Cancer Registry data to identify all adult patients diagnosed with bladder cancer. Our primary outcome was locoregional stage of diagnosis, since treatment modality changes and prognosis worsens beyond this stage. Based on patient's residential location at the time of diagnosis we defined both density of urologists and number of primary care providers (defined as providers per population) within the patient's county. We used univariate and multivariate logistic regression to estimate the association between provider density and likelihood of locoregional stage of diagnosis. We also controlled for age, sex, race/ethnicity, insurance type, and year. RESULTS Our sample included 11,771 urinary bladder cancer patients with 10,607 diagnosed at locoregional stage and 1164 at distant stage. Multivariate regression results show primary care density was associated with significantly higher odds of locoregional stage of diagnosis (odds ratio of 1.05 [95% CI: 1.02-1.08]) while urologist density was associated with significantly lower odds of locoregional stage (odds ratio of 0.65 [95% CI: 0.48-0.89]). CONCLUSIONS We found primary care density but not urologist density was associated with earlier stage of diagnosis, highlighting the importance of access to primary care and need for timely referral to urologic care.
Collapse
Affiliation(s)
- Joel E Segel
- Department of Health Policy and Administration, Penn State University, University Park, Pennsylvania
- Penn State Cancer Institute, Hershey, Pennsylvania
- Department of Public Health Sciences, Penn State University, Hershey, Pennsylvania
| | - William G Wong
- Department of Surgery, Penn State College of Medicine, Hershey, Pennsylvania
| | - Matthew Kaag
- Department of Urology, Penn State College of Medicine, Hershey, Pennsylvania
| | - Monika Joshi
- Penn State Cancer Institute, Hershey, Pennsylvania
- Department of Medicine, Division of Hematology-Oncology, Penn State College of Medicine, Hershey, Pennsylvania
| | - Joshua Warrick
- Penn State Cancer Institute, Hershey, Pennsylvania
- Department of Urology, Penn State College of Medicine, Hershey, Pennsylvania
- Department of Pathology, Penn State College of Medicine, Hershey, Pennsylvania
| | - Eugene J Lengerich
- Penn State Cancer Institute, Hershey, Pennsylvania
- Department of Public Health Sciences, Penn State University, Hershey, Pennsylvania
| | - Chan Shen
- Penn State Cancer Institute, Hershey, Pennsylvania
- Department of Public Health Sciences, Penn State University, Hershey, Pennsylvania
- Department of Surgery, Penn State College of Medicine, Hershey, Pennsylvania
| |
Collapse
|
7
|
Shen C, Thornton JD, Li N, Schaefer E, Zhou S, Kawasaki S, Pameijer C, Leslie D. Opioid and Non-Opioid Pharmacotherapy Use for Pain Management Among Privately Insured Pediatric Patients With Cancer in the United States. Oncologist 2024; 29:176-184. [PMID: 37944042 PMCID: PMC10836308 DOI: 10.1093/oncolo/oyad292] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 10/10/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND This study examined the trends and patterns of opioid and non-opioid pharmacotherapy use among a large national sample of privately insured pediatric patients with cancer in the United States. MATERIALS AND METHODS We identified pediatric (aged < 21) patients diagnosed with central nervous system (CNS), lymphoma, gonadal, leukemia, or bone cancer from MarketScan data 2005-2019. We examined the proportion of patients who filled a prescription for the following 5 types of pharmacotherapy: opioid, anticonvulsant, non-steroidal anti-inflammatory drug (NSAID), antidepressant, and muscle relaxant during active cancer treatment. We assessed the trends and patterns in pharmacotherapy using multivariable logistic regressions. RESULTS Among 4174 patients included, 2979 (71%) had an opioid prescription; 746 (18%), 384 (9%), 202 (5%), and 169 (4%) had anticonvulsant, NSAID, antidepressant and muscle relaxant prescriptions, respectively. Multivariable logistic regression showed a nonlinear trend in the use of opioids among pediatric patients with cancer over time such that use slightly increased until 2012 (OR of 1.40 [95% CI, 1.12-1.73] for 2012 vs. 2006) but then decreased thereafter (OR of 0.51 [0.37-0.68] for 2018 vs. 2012). The use of anticonvulsants, NSAIDs, and muscle relaxants increased significantly linearly over time (all P < .005). CONCLUSION There has been a downward trend in the use of opioids in recent years among pediatric patients with cancer and an upward trend in the use of non-opioid pharmacotherapy for pain management potentially as an alternative to opioids.
Collapse
Affiliation(s)
- Chan Shen
- Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
- Department of Public Health Sciences, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - J Douglas Thornton
- Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, TX, USA
| | - Ning Li
- Department of Economics and Finance, Salisbury University, Salisbury, MD, USA
| | - Eric Schaefer
- Department of Public Health Sciences, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - Shouhao Zhou
- Department of Public Health Sciences, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - Sarah Kawasaki
- Department of Psychiatry and Behavioral Health, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Colette Pameijer
- Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - Douglas Leslie
- Department of Public Health Sciences, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
| |
Collapse
|
8
|
Olecki EJ, Perez Holguin RA, Mayhew MM, Wong WG, Vining CC, Peng JS, Shen C, Dixon MEB. Disparities in Surgical Treatment of Resectable Pancreatic Adenocarcinoma at Minority Serving Hospitals. J Surg Res 2024; 294:160-168. [PMID: 37897875 DOI: 10.1016/j.jss.2023.09.066] [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: 05/18/2023] [Revised: 09/02/2023] [Accepted: 09/24/2023] [Indexed: 10/30/2023]
Abstract
INTRODUCTION Minority serving hospitals (MSH) are those serving a disproportionally high number of minority patients. Previous research has demonstrated that treatment at MSH is associated with worse outcomes. We hypothesize that patients treated at MSH are less likely to undergo surgical resection of pancreatic adenocarcinoma compared to patients treated at non-MSH. METHODS Patients with resectable pancreatic cancer were identified using the National Cancer Database. Institutions treating Black and Hispanic patients in the top decile were categorized as an MSH. Factors associated with the primary outcome of definitive surgical resection were evaluated using multivariable logistic regression. Univariate and multivariable survival analysis was performed. RESULTS Of the 75,513 patients included in this study, 7.2% were treated at MSH. Patients treated at MSH were younger, more likely to be uninsured, and higher stage compared to those treated at non-MSH (P < 0.001). Patients treated at MSH underwent surgical resection at lower rates (MSH 40% versus non-MSH 44.5%, P < 0.001). On multivariable logistic regression, treatment at MSH was associated with decreased likelihood of undergoing definitive surgery (odds ratio 0.91, P = 0.006). Of those who underwent surgical resection, multivariable survival analysis revealed that treatment at an MSH was associated with increased morality (hazard ratio 1.12, P < 0.001). CONCLUSIONS Patients with resectable pancreatic adenocarcinoma treated at MSH are less likely to undergo surgical resection compared to those treated at non-MSH. Targeted interventions are needed to address the unique barriers facing MSH facilities in providing care to patients with pancreatic adenocarcinoma.
Collapse
Affiliation(s)
- Elizabeth J Olecki
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania.
| | - Rolfy A Perez Holguin
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania
| | - Mackenzie M Mayhew
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania
| | - William G Wong
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania
| | - Charles C Vining
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania; Program for Liver, Pancreas & Foregut Tumors, Division of Surgical Oncology, Penn State Milton S Hershey Medical Center, Hershey, Pennsylvania
| | - June S Peng
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania; Program for Liver, Pancreas & Foregut Tumors, Division of Surgical Oncology, Penn State Milton S Hershey Medical Center, Hershey, Pennsylvania
| | - Chan Shen
- Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania
| | - Matthew E B Dixon
- Department of Surgery, Rush University Medical College, Chicago, Illinois; Section of Hepatopancreatobiliary Surgery, Division of Surgical Oncology, Rush University Medical Center, Chicago, Illinois
| |
Collapse
|
9
|
Ikram M, Shen C, Pameijer CR. Racial and Socioeconomic Differences and Surgical Outcomes in Pancreaticoduodenectomy Patients: A Systematic Review of High- Versus Low-Volume Hospitals in the United States. Am Surg 2024; 90:292-302. [PMID: 37941362 DOI: 10.1177/00031348231211040] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
BACKGROUND Pancreaticoduodenectomy (PD) is associated with better outcomes in high-volume hospitals. However, it is unknown whether and to what extent the improved performance of high-volume hospitals may be associated with racial and socioeconomic factors, which have been shown to impact operative and postoperative outcomes in major surgeries. This review aims to identify the differences in racial and socioeconomic characteristics of patients who underwent PD surgery in high- and low-volume hospitals. METHODS PubMed, Cochrane, and Web of Science were systematically searched between May 1, 2023 and May 7, 2023 without any time restriction on publication date. Studies that were conducted in the United States and had a direct comparison between high- and low-volume hospitals were included. RESULTS A total of 30 observational studies were included. When racial proportions were compared by hospital volume, thirteen studies reported that compared to high-volume hospitals, a higher percentage of racial minorities underwent PD in low-volume hospitals. Disparities in traveling distance, education levels, and median income at baseline between high- and low-volume hospitals were reported by four, three, and two studies, respectively. CONCLUSION A racial difference at baseline between high- and low-volume hospitals was observed. Socioeconomic factors were less frequently included in existing literature. Future studies are needed to understand the socioeconomic differences between patients receiving PD surgery in high- and low-volume hospitals.
Collapse
Affiliation(s)
- Mohammad Ikram
- Department of Surgery, Division of Outcomes Research and Quality, College of Medicine, The Pennsylvania State University, Hershey, PA, USA
| | - Chan Shen
- Department of Surgery, Division of Outcomes Research and Quality, College of Medicine, The Pennsylvania State University, Hershey, PA, USA
- Department of Public Health Sciences, Division of Health Services and Behavioral Research, College of Medicine, The Pennsylvania State University, Hershey, PA, USA
| | - Colette R Pameijer
- Department of Surgery, Division of Surgical Oncology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| |
Collapse
|
10
|
Mitra S, Shen C, Pinnamraju J, Wiener RC, Wang H, Pathak M, Findley PA, Sambamoorthi U. Stress Due to Inflation: Changes over Time, Correlates, and Coping Strategies among Working-Age Adults in the United States. Int J Environ Res Public Health 2024; 21:157. [PMID: 38397647 PMCID: PMC10887512 DOI: 10.3390/ijerph21020157] [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] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 01/13/2024] [Accepted: 01/26/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND During the COVID-19 pandemic, the annual US inflation rate increased from 1.2% in July 2020 to 8% in July 2022. It has since declined to 3.4% (December 2023). This study examined the prevalence of stress due to inflation during a period when it declined from 8.2% in September 2022 to 3% in June 2023 and its association with demographic and social determinants of health (SDOH). METHODS We conducted a cross-sectional analysis of the online Household Pulse Survey (HPS), which surveils the experiences of US households. Beginning September 2022, HPS initiated data collection on "stress due to inflation" through a question on how stressful the increase in prices in the last 2 months has been. Participants could respond: very, moderately, a little, or not stressful. We analyzed data on working-age adults (18-64 years) who responded to the above question of stress due to inflation during 14-26 September 2022 (N = 32,579) and 7-19 June 2023 (N = 36,229). We used replicate weights in chi-squared tests and ordinal logistic regression analyses controlling for gender, age, race and ethnicity, COVID-19, COVID-19 vaccination, health insurance, and SDOH, including education, lost employment income, poverty status, marital status, food affordability, and region. RESULTS The prevalence of stress due to inflation (price increases being very or moderately stressful) significantly increased from 76.9% in September 2022 to 78.9% in June 2023. The odds of stress due to inflation were higher for individuals with the following characteristics: female, transgender, having income below 400% of the federal poverty line, having lost employment income, not being able to afford food, had long or acute COVID-19, and did not have a COVID-19 vaccine. CONCLUSIONS More than three quarters of working-age adults in the US experienced stress due to inflation. Despite a declining national inflation rate in recent months, stress due to inflation has significantly increased among working-age adults. Inflation-related stress warrants further research and policy attention.
Collapse
Affiliation(s)
- Sophie Mitra
- Department of Economics, Fordham University, 441 East Fordham Road, Bronx, NY 10458, USA
| | - Chan Shen
- Department of Surgery, Penn State Cancer Institute, Hershey, PA 17033, USA
| | - Jahnavi Pinnamraju
- Department of Pharmacotherapy, College of Pharmacy, University of North Texas Health Science Center, Fort Worth, TX 76107, USA
| | - R. Constance Wiener
- Department of Pharmacotherapy, College of Pharmacy, University of North Texas Health Science Center, Fort Worth, TX 76107, USA
- Department of Dental Public Health and Professional Practice, West Virginia University, Morgantown, WV 26506, USA
| | - Hao Wang
- Department of Emergency Medicine, JPS Health Network, Integrative Emergency Services, Fort Worth, TX 76104, USA
| | - Mona Pathak
- Department of Pharmacotherapy, College of Pharmacy, University of North Texas Health Science Center, Fort Worth, TX 76107, USA
| | | | - Usha Sambamoorthi
- Department of Pharmacotherapy, College of Pharmacy, University of North Texas Health Science Center, Fort Worth, TX 76107, USA
| |
Collapse
|
11
|
Kang DW, Zhou S, Niranjan S, Rogers A, Shen C. Predicting operative time for metabolic and bariatric surgery using machine learning models: A retrospective observational study. Int J Surg 2024; 110:01279778-990000000-01013. [PMID: 38270635 PMCID: PMC11019972 DOI: 10.1097/js9.0000000000001107] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 01/08/2024] [Indexed: 01/26/2024]
Abstract
BACKGROUND Predicting operative time is essential for scheduling surgery and managing the operating room (OR). This study aimed to develop machine learning (ML) models to predict the operative time for metabolic and bariatric surgery (MBS) and to compare each model. METHODS We used the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database between 2016 and 2020 to develop ML models, including linear regression, random forest (RF), support vector machine, gradient-boosted tree, and XGBoost model. Patient characteristics and surgical features were included as variables in the model. We used the mean absolute error (MAE), root mean square error (RMSE), and R2 score to evaluate model performance. We identified the ten most important variables in the best-performing model using the Shapley Additive exPlanations algorithm. RESULTS In total, 668,723 patients were included in the study. The XGBoost model outperformed the other ML models, with the lowest RMSE and highest R2 score. RF performed better than linear regression. The relative performance of the ML algorithms remained consistent across the models, regardless of the surgery type. The surgery type and surgical approach were the most important features to predict the operative time; specifically, sleeve gastrectomy (vs. Roux-en-Y gastric bypass) and the laparoscopic approach (vs. robotic-assisted approach) were associated with a shorter operative time. CONCLUSIONS The XGBoost model best predicted the operative time for MBS among the ML models examined. Our findings can be useful in managing OR scheduling and in developing software tools to predict the operative times of MBS in clinical settings.
Collapse
Affiliation(s)
- Dong-Won Kang
- Department of Surgery, Penn State College of Medicine
| | - Shouhao Zhou
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - Suman Niranjan
- Department of Logistics and Operations Management, G. Brint Ryan College of Business, University of North Texas, Denton, Texas, USA
| | - Ann Rogers
- Department of Surgery, Penn State College of Medicine
| | - Chan Shen
- Department of Surgery, Penn State College of Medicine
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| |
Collapse
|
12
|
Wang H, Pathak M, Takami T, Wiener RC, Shen C, Sambamoorthi U. Ethnic Disparities in Patient-Centered Communication with Healthcare Providers: A Comparison of Non-Hispanic Asians and Non-Hispanic Whites. J Racial Ethn Health Disparities 2024:10.1007/s40615-023-01898-7. [PMID: 38228862 DOI: 10.1007/s40615-023-01898-7] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 12/09/2023] [Accepted: 12/15/2023] [Indexed: 01/18/2024]
Abstract
BACKGROUND Patient-centered communication (PCC) is an important metric related to patient health outcomes. Non-Hispanic Asian (NHA) individuals reported lower PCC scores with healthcare providers than individuals of other races and ethnicities. We aim to determine the ethnic disparities in PCC and further investigate the association between PCC, individual's confidence in obtaining health-related information (health literacy), and confidence in taking care of themselves (health self-efficacy) among NHA in comparison to the Non-Hispanic White (NHW) population. METHODS This is a cross-sectional study. We used data from the Health Information National Trends Survey 5 (HINTS) cycles 1 and 3. PCC was measured using seven validated survey questions with scores ranging from 7 to 28. Individuals' health literacy and self-efficacy were accessed using two-item survey questions. Multivariable logistic regression analyses were performed to determine the association of independent factors (e.g., self-efficacy, health literacy, and race and ethnicity) with PCC. RESULTS We included 3,831 participants. Fewer NHAs (35.43%) reported high PCC scores compared to NHWs (48.99%, p = 0.0184). In fully adjusted logistic regression model, although NHAs were less likely to have high PCC scores (aOR = 0.78, 95% CI 0.46-1.32) compared to NHWs, the association was not statistically significant (p = 0.350). However, the aOR of confidence in self-efficacy associated with high PCC scores was 2.27 (95% CI 1.68-3.07, p < 0.001) and the aOR of confidence in health literacy with high PCC scores was 2.13 (95% CI 1.64-2.76, p < 0.001). CONCLUSIONS High PCC scores reported by NHA were not significantly different from those of NHW individuals in adjusted comparisons. Individual's confidence in self-efficacy and health literacy was positively associated with high PCC regardless of race and ethnicity.
Collapse
Affiliation(s)
- Hao Wang
- Department of Emergency Medicine, JPS Health Network, 1500 S. Main St., Fort Worth, TX, 76104, USA.
| | - Mona Pathak
- Department of Pharmacotherapy, College of Pharmacy, Texas Center for Health Disparities, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Trevor Takami
- Department of Emergency Medicine, JPS Health Network, 1500 S. Main St., Fort Worth, TX, 76104, USA
| | - R Constance Wiener
- Department of Dental Public Health and Professional Practice, School of Dentistry, West Virginia University, Morgantown, WV, USA
| | - Chan Shen
- Department of Health Services Research, Penn State College of Medicine, Hershey, PA, USA
| | - Usha Sambamoorthi
- Department of Pharmacotherapy, College of Pharmacy, Texas Center for Health Disparities, University of North Texas Health Science Center, Fort Worth, TX, USA
| |
Collapse
|
13
|
Wong WG, Perez Holguin RA, Kanwar R, Dodge D, Shen C. Management of Male Patients With Occult Breast Cancer: Analysis of the National Cancer Database. J Surg Res 2024; 293:685-692. [PMID: 37839100 DOI: 10.1016/j.jss.2023.08.053] [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: 06/22/2023] [Revised: 07/24/2023] [Accepted: 08/27/2023] [Indexed: 10/17/2023]
Abstract
INTRODUCTION Occult breast cancer (OBC) consists of <0.1% of breast cancer cases in the United States. Male occult breast cancer (mOBC) has not been well-studied outside of case reports, and management is largely based on female OBC (fOBC) studies. We aim to examine the prevalence of mOBC among those in the National Cancer Database with breast cancer and describe treatment modalities received by mOBC compared to fOBC. METHODS The National Cancer Database was queried for patients with OBC from 2004 to 2018. Chi-Square test and Fisher's exact tests compared patient, clinical, and facility characteristics by sex. Treatment modalities [systemic therapy, radiation therapy, axillary lymph node dissection, modified radical mastectomy (MRM)] were compared. A subgroup analysis examined pathologic upstaging in patients who underwent MRM. RESULTS Of 23,374 male patients with breast cancer, 0.13% were identified to have mOBC [versus 0.09% in fOBC]. cN2/N3 disease was significantly more prevalent in the mOBC cohort (61.3%) than in the fOBC cohort (30.7%, P < 0.001). Receipt of axillary lymph node dissection or MRM was not significantly different by sex. Male OBC (mOBC) patients were less likely to receive trimodality treatment than fOBC patients. In patients who underwent MRM, more mOBC patients [75%] were pathologically upstaged as T+ after mastectomy than fOBC patients [30%, P < 0.001], questioning the adequacy of diagnostic workup for mOBC compared to fOBC. CONCLUSIONS This review confirms mOBC as an extremely rare disease. Multimodal treatments have been highly utilized to optimize care in this patient population. Further investigation is warranted to examine the survival benefit of treatment regimens for mOBC.
Collapse
Affiliation(s)
- William G Wong
- PennState Milton S. Hershey Medical Center, General Surgery, Hershey, Pennsylvania
| | | | - Rhea Kanwar
- Penn State College of Medicine, Hershey, Pennsylvania
| | - Daleela Dodge
- PennState Milton S. Hershey Medical Center, General Surgery, Hershey, Pennsylvania
| | - Chan Shen
- Division of Outcomes Research, and Quality, PennState Milton S. Hershey Medical Center, Hershey, Pennsylvania.
| |
Collapse
|
14
|
Shen C, Thornton JD, Li N, Zhou S, Wang L, Leslie DL, Kawasaki SS. Opioid Overdose Hospitalizations During COVID-19: The Experience of Pennsylvania. Subst Use 2024; 18:11782218231222343. [PMID: 38433749 PMCID: PMC10906497 DOI: 10.1177/11782218231222343] [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] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 12/07/2023] [Indexed: 03/05/2024]
Abstract
Objective The COVID-19 pandemic placed extreme burden on hospitals, while opioid overdose is another challenging public health issue. This study aimed to examine the trends and outcomes of opioid overdose hospitalizations in Pennsylvania during 2018 to 2021. Design We identified opioid overdose hospitalizations in the state of Pennsylvania using the state-wide hospital discharge database (PHC4) 2018 to 2021. We examined the number of opioid overdose hospitalizations, the corresponding mortality and discharges against medical advice comparing the pre-COVID period (2018-2019) and the COVID period (2020-2021). We also assessed what patient and hospital characteristics were associated with in-hospital death or leaving against medical advice. Results A total of 13 446 opioid-related hospitalizations were identified in 2018 to 2021. Compared to pre-pandemic, a higher percentage of cases involving synthetics (17.0%vs 10.3%, P < .0001) were observed during COVID. After controlling for covariates, there was no significant difference in opioid overdose in-hospital deaths in the years 2020 to 2021 compared to 2018 to 2019 (OR = 0.846, 95% CI: 0.71-1.01, P = .065). The COVID period was significantly associated with more leaving against medical advice compared to years 2018 to 2019 (OR = 1.265, 95% CI: 1.11-1.44, P = .0003). Compared to commercial insurance, Medicaid insurance was associated with higher odds of both in-hospital death (OR = 1.383, 95% CI: 1.06-1.81, P = .0176) and leaving against medical advice (OR = 1.903, 95% CI: 1.56-2.33, P < .0001). Conclusion There were no substantial changes in the number of overall opioid overdose cases and deaths at hospitals following the outbreak of COVID-19 in Pennsylvania. This observation suggests that an increased number of patients may have succumbed to overdoses outside of hospital settings, possibly due to a higher severity of overdoses. Further, we found that patients were more likely to leave against medical advice during the COVID-19 pandemic.
Collapse
Affiliation(s)
- Chan Shen
- Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
- Department of Public Health Sciences, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - James Douglas Thornton
- Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, TX, USA
| | - Ning Li
- Department of Economics and Finance, Salisbury University, Salisbury, MD, USA
| | - Shouhao Zhou
- Department of Public Health Sciences, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - Li Wang
- Department of Public Health Sciences, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - Douglas L. Leslie
- Department of Public Health Sciences, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - Sarah S. Kawasaki
- Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| |
Collapse
|
15
|
Moss JL, Ledford SG, Bernacchi V, Shen C. Hospital- and county-level characteristics explain geographic variability in prices of cancer-related procedures: Implications for policy and interventions. Cancer Med 2023; 13:e6792. [PMID: 38131646 PMCID: PMC10807617 DOI: 10.1002/cam4.6792] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 11/10/2023] [Accepted: 11/23/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Healthcare costs in the U.S. are high and variable, which can hinder access and impact health outcomes across communities. This study examined hospital- and county-level characteristics to identify factors that explain geographic variation in prices for four cancer-related procedures. METHODS Data sources included Turquoise Health, which compiles publicly-available price data from U.S. hospitals. We examined list prices for four procedures: abdominal ultrasound, diagnostic colonoscopy, brain MRI, and pelvis CT scan, which we linked to characteristics of hospitals (e.g., number of beds) and counties (e.g., metropolitan status). We used multilevel linear regression models to assess multivariable relationships between prices and hospital- and county-level characteristics. Supplementary analyses repeated these models using procedures prices for commercial insurance plans. RESULTS For each procedure, list prices varied across counties (intraclass correlation: abdominal ultrasound = 23.2%; colonoscopy = 17.1%; brain MRI = 37.2%; pelvis CT = 50.9%). List prices for each procedure were associated with hospital ownership (all p < 0.001) and percent of population without health insurance (all p < 0.05). For example, list prices for abdominal ultrasound were higher for proprietary versus Government-owned hospitals (β = 539.10, 95% confidence interval [CI]: 256.12, 822.08, p < 0.001) and for hospitals in counties with more uninsured residents (β = 23.44, 95% CI: 2.55, 44.33, p = 0.03). Commercial insurance prices were negatively associated with metropolitan status. CONCLUSIONS Prices for cancer-related healthcare procedures varied substantially, with considerable heterogeneity associated with county location as well as county-level social determinants of health (e.g., health insurance coverage). Interventions and policy changes are needed to alleviate the financial burden of cancer care among patients, including geographic variation in prices for cancer-related procedures.
Collapse
Affiliation(s)
- Jennifer L. Moss
- Department of Family and Community MedicinePenn State College of Medicine, The Pennsylvania State UniversityHersheyPennsylvaniaUSA
- Department of Public Health SciencesPenn State College of Medicine, The Pennsylvania State UniversityHersheyPennsylvaniaUSA
| | - Savanna G. Ledford
- Department of Public Health SciencesPenn State College of Medicine, The Pennsylvania State UniversityHersheyPennsylvaniaUSA
| | - Veronica Bernacchi
- Department of Family and Community MedicinePenn State College of Medicine, The Pennsylvania State UniversityHersheyPennsylvaniaUSA
| | - Chan Shen
- Department of Public Health SciencesPenn State College of Medicine, The Pennsylvania State UniversityHersheyPennsylvaniaUSA
- Department of SurgeryPenn State College of Medicine, The Pennsylvania State UniversityHersheyPennsylvaniaUSA
| |
Collapse
|
16
|
Kawasaki SS, Zimmerman R, Shen C, Zgierska AE. COVID-19-related flexibility in methadone take-home doses associated with decreased attrition: Report from an opioid treatment program in central Pennsylvania. J Subst Use Addict Treat 2023; 155:209164. [PMID: 37730014 DOI: 10.1016/j.josat.2023.209164] [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] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 09/12/2023] [Accepted: 09/12/2023] [Indexed: 09/22/2023]
Abstract
INTRODUCTION Pennsylvania saw a dramatic increase in take-home doses of methadone after the COVID-19 pandemic-related relaxation in regulations. We evaluated whether pandemic-initiated relaxation in take-home methadone dose regulations was associated with changes in attrition and urine drug test (UDT) results at one outpatient opioid treatment program (OTP) among adult patients treated with methadone for opioid use disorder (OUD). METHODS We analyzed aggregated, retrospective clinical practice data, using data abstracted from the OTP's electronic health record (EHR) on the number of patients treated with methadone, those allowed take-home doses, the number of take-home methadone doses dispensed, and the number and type of patient discharge ("attrition") from treatments for 12 months before (March 2019-February 2020; "pre-pandemic") and 12 months after (March 2020-February 2021; "pandemic") the regulatory changes took place. We also examined monthly aggregate data on the number of urine samples testing positive for amphetamines, cocaine, benzodiazepines or illicit opioids, and compared these findings between the pre-pandemic and pandemic periods. RESULTS Pre-pandemic, 229 patients were treated with methadone, compared to 278 patients during the pandemic period. They received 11,047 and 28,563 take-home daily-doses of methadone (p < 0.0001) during each assessment period, respectively. All-cause treatment attrition (discharge from the program for any reason) decreased from 27.1 % in the pre-pandemic to 15.5 % in the pandemic period (p < 0.001). Compared to pre-pandemic, during the pandemic period the urine toxicology testing showed reduced positivity rates for cocaine (26.4 % vs 18.9 %, p < 0.001), and oxycodone and morphine (1.8 % vs 1.1 %, p < 0.019), and increased for fentanyl (24.0 % vs 30.5 %, p < 0.007), without statistically significant changes for benzodiazepines or amphetamines. CONCLUSIONS The relaxation of regulations guiding take-home methadone doses accompanied reduced treatment attrition and favorable changes in urine toxicology results in one OTP. Allowing OTPs to apply flexible decisions regarding take-home methadone doses could improve treatment retention, outcomes, and, in turn, save lives.
Collapse
Affiliation(s)
| | | | - Chan Shen
- Penn State College of Medicine, Hershey, PA, United States
| | | |
Collapse
|
17
|
Song MF, Ma LY, Zhao Q, Shen C, Zhao CY. [Research progress on the mechanism and response strategies of molecular targeted drug resistance in liver cancer]. Zhonghua Gan Zang Bing Za Zhi 2023; 31:1108-1112. [PMID: 38016782 DOI: 10.3760/cma.j.cn501113-20220723-00393] [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] [Grants] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
Molecular targeted drugs are one of the treatments for hepatocellular carcinoma (HCC), the primary factor influencing their therapeutic efficacy is drug resistance. Diminished drug intake, greater efflux, improved DNA damage repair capacity, aberrant signal pathways, hypoxia, epithelial-mesenchymal cell transition, and the cellular autophagy system are summarized herein as aspects of the drug resistance mechanism. Simultaneously, effective strategies for addressing drug resistance are elaborated, providing ideas for better clinical treatment of HCC.
Collapse
Affiliation(s)
- M F Song
- Department of Infectious Disease, the Third Hospital of Hebei Medical University, Shijiazhuang 050051, China
| | - L Y Ma
- Department of Infectious Disease, the Third Hospital of Hebei Medical University, Shijiazhuang 050051, China
| | - Q Zhao
- Quality Management and Control Office, the Third Hospital of Hebei Medical University, Shijiazhuang 050051, China
| | - C Shen
- Department of Infectious Disease, the Third Hospital of Hebei Medical University, Shijiazhuang 050051, China
| | - C Y Zhao
- Department of Infectious Disease, the Third Hospital of Hebei Medical University, Shijiazhuang 050051, China
| |
Collapse
|
18
|
Fang X, Liu X, Chinchilli VM, Wang M, Wang HG, Dokholyan NV, Shen C, Lee JJ, Zhou S. REAP-2: An interactive quantitative tool for robust and efficient dose-response curve estimation. J Clin Transl Sci 2023; 7:e219. [PMID: 38028338 PMCID: PMC10643933 DOI: 10.1017/cts.2023.642] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 09/18/2023] [Accepted: 09/21/2023] [Indexed: 12/01/2023] Open
Abstract
REAP-2 is an interactive dose-response curve estimation tool for Robust and Efficient Assessment of drug Potency. It provides user-friendly dose-response curve estimation for in vitro studies and conducts statistical testing for model comparisons with a redesigned user interface. We also make a major update of the underlying estimation method with penalized beta regression, which demonstrates great reliability and accuracy in dose estimation and uncertainty quantification. In this note, we describe the method and implementation of REAP-2 with a highlight on potency estimation and drug comparison.
Collapse
Affiliation(s)
- Xinying Fang
- Department of Public Health Sciences, Pennsylvania State University, Hershey, PA, USA
| | - Xinyi Liu
- Department of Public Health Sciences, Pennsylvania State University, Hershey, PA, USA
| | - Vernon M. Chinchilli
- Department of Public Health Sciences, Pennsylvania State University, Hershey, PA, USA
| | - Michael Wang
- Department of Lymphoma and Myeloma, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Hong-Gang Wang
- Department of Pharmacology, Pennsylvania State University, Hershey, PA, USA
- Department of Pediatrics, Pennsylvania State University, Hershey, PA, USA
| | - Nikolay V. Dokholyan
- Department of Pharmacology, Pennsylvania State University, Hershey, PA, USA
- Department of Biochemistry and Molecular Biology, Pennsylvania State University, Hershey, PA, USA
| | - Chan Shen
- Department of Public Health Sciences, Pennsylvania State University, Hershey, PA, USA
- Department of Surgery, The Pennsylvania State University, Hershey, PA, USA
| | - J. Jack Lee
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Shouhao Zhou
- Department of Public Health Sciences, Pennsylvania State University, Hershey, PA, USA
| |
Collapse
|
19
|
Liu K, Chen YJ, Su J, Fan XK, Yu H, Qin Y, Yang J, Zhu Z, Guan HY, Shen C, Pan EC, Lu Y, Zhou JY, Wu M. [Association of category of dietary intake and physical activity with the risk of mortality in patients with type 2 diabetes mellitus: a prospective cohort study]. Zhonghua Liu Xing Bing Xue Za Zhi 2023; 44:1591-1598. [PMID: 37875446 DOI: 10.3760/cma.j.cn112338-20230328-00188] [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] [Grants] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Abstract
Objective: To investigate the association between dietary intake and physical activity category and their combined effects on all-cause and cause-specific mortality risk in patients with type 2 diabetes mellitus (T2DM). Methods: Between December 2013 and December 2021, a prospective cohort study was conducted on 19 863 T2DM patients in Changshu City, Qingjiangpu District (formerly Qinghe District), and Huai'an District, included in the national basic health service management. Information on deaths and underlying causes of death was obtained from the Jiangsu Provincial CDC and Prevention Death Surveillance System. Cox proportional hazards models were used to estimate the intensity of associations between dietary intake, physical activity, and their combined effects with all-cause and cause-specific mortality in patients with T2DM. Results: As of December 31, 2021, the research subjects had been followed up for 150 283 person-years, with a median follow-up time of 8.15 years. During the follow-up period, 3 293 people died, including 1 124 deaths from cardiovascular disease (CVD) and 875 deaths from cancer. Cox regression analysis showed that compared with the population of 0-1 recommended food group, those having more than five recommended food groups had a 19% lower risk of all-cause mortality [hazard ratio (HR)=0.81, 95%CI: 0.70-0.94] and a 33% lower risk of all-cause mortality (HR=0.67, 95%CI: 0.52-0.87). Compared with the T2DM population in the physical activity Q1 group, the risk of all-cause mortality, CVD mortality, and cancer mortality among the physical activity Q4 group reduced by 50% (HR=0.50, 95%CI: 0.45-0.56), 50% (HR=0.50, 95%CI: 0.41-0.61), and 27% (HR=0.73, 95%CI: 0.60-0.88), respectively. The combined effect showed that compared with the population in the intake of food categories 0-2 and low physical activity groups, the risk of all-cause, CVD mortality, and cancer mortality in the intake of food categories 4-9 and high physical activity groups reduced by 55% (HR=0.45, 95%CI: 0.38-0.53), 56% (HR=0.44, 95%CI: 0.32-0.59), and 40% (HR=0.60, 95%CI: 0.44-0.82), respectively. Conclusion: Type of dietary intake, physical activity, and their combined effects are associated with a reduced mortality risk in patients with T2DM.
Collapse
Affiliation(s)
- K Liu
- School of Public Health, Southeast University, Nanjing 210009, China
| | - Y J Chen
- Department of Non-communicable Chronic Disease Control and Prevention, Nanjing Center for Disease Control and Prevention, Nanjing 210003, China
| | - J Su
- Department of Non-communicable Chronic Disease Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China
| | - X K Fan
- Department of Non-communicable Chronic Disease Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China
| | - H Yu
- Department of Non-communicable Chronic Disease Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China
| | - Y Qin
- Department of Non-communicable Chronic Disease Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China
| | - J Yang
- Department of Non-communicable Chronic Disease Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China
| | - Z Zhu
- Department of Non-communicable Chronic Disease Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China
| | - H Y Guan
- School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - C Shen
- School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - E C Pan
- Department of Chronic Disease Prevention and Control, Huai'an City Center for Disease Control and Prevention, Huai'an 223001, China
| | - Y Lu
- Department of Chronic Disease Prevention and Control, Suzhou City Center for Disease Control and Prevention, Suzhou 215004, China
| | - J Y Zhou
- Department of Non-communicable Chronic Disease Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China
| | - M Wu
- School of Public Health, Southeast University, Nanjing 210009, China Department of Non-communicable Chronic Disease Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China
| |
Collapse
|
20
|
Snyder RA, Burtness B, Cho M, Del Rivero J, Doroshow DB, Hitchcock KE, Kalyan A, Kim CA, Lukovic J, Parikh AR, Sanford NN, Singh B, Shen C, Shroff RT, Vijayvergia N, Goodman KA, Kunz PL. The room where it happens: addressing diversity, equity, and inclusion in National Clinical Trials Network clinical trial leadership. J Natl Cancer Inst 2023; 115:1132-1138. [PMID: 37364007 PMCID: PMC11009492 DOI: 10.1093/jnci/djad121] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 06/09/2023] [Accepted: 06/22/2023] [Indexed: 06/28/2023] Open
Abstract
Many multicenter randomized clinical trials in oncology are conducted through the National Clinical Trials Network (NCTN), an organization consisting of 5 cooperative groups. These groups are made up of multidisciplinary investigators who work collaboratively to conduct trials that test novel therapies and establish best practice for cancer care. Unfortunately, disparities in clinical trial leadership are evident. To examine the current state of diversity, equity, and inclusion across the NCTN, an independent NCTN Task Force for Diversity in Gastrointestinal Oncology was established in 2021, the efforts of which serve as the platform for this commentary. The task force sought to assess existing data on demographics and policies across NCTN groups. Differences in infrastructure and policies were identified across groups as well as a general lack of data regarding the composition of group membership and leadership. In the context of growing momentum around diversity, equity, and inclusion in cancer research, the National Cancer Institute established the Equity and Inclusion Program, which is working to establish benchmark data regarding diversity of representation within the NCTN groups. Pending these data, additional efforts are recommended to address diversity within the NCTN, including standardizing membership, leadership, and publication processes; ensuring diversity of representation across scientific and steering committees; and providing mentorship and training opportunities for women and individuals from underrepresented groups. Intentional and focused efforts are necessary to ensure diversity in clinical trial leadership and to encourage design of trials that are inclusive and representative of the broad population of patients with cancer in the United States.
Collapse
Affiliation(s)
- Rebecca A Snyder
- Departments of Surgical Oncology and Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Barbara Burtness
- Department of Internal Medicine, Section of Medical Oncology, and Yale Cancer Center, Yale School of Medicine, New Haven, CT, USA
| | - May Cho
- Department of Medicine, Division of Hematology/Oncology, University of California, Irvine, Irvine, CA, USA
| | - Jaydira Del Rivero
- Developmental Therapeutics Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Deborah B Doroshow
- Department of Medicine, Division of Hematology and Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kathryn E Hitchcock
- Department of Radiation Oncology, University of Florida, Gainesville, FL, USA
| | - Aparna Kalyan
- Department of Medicine, Division of Hematology & Oncology and Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA
| | - Christina A Kim
- Department of Internal Medicine, Section of Medical Oncology and Hematology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Jelena Lukovic
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network and Department of Radiation Oncology, University of Toronto, ON, Canada
| | - Aparna R Parikh
- Massachusetts General Cancer Center, Division of Hematology/Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Nina N Sanford
- Department of Radiation Oncology, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Bhuminder Singh
- Department of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Chan Shen
- Departments of Surgery and Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Rachna T Shroff
- Department of Medicine, Division of Hematology/Oncology, University of Arizona Cancer Center, Tucson, AZ, USA
| | - Namrata Vijayvergia
- Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Karyn A Goodman
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Pamela L Kunz
- Department of Internal Medicine, Section of Medical Oncology, and Yale Cancer Center, Yale School of Medicine, New Haven, CT, USA
| |
Collapse
|
21
|
Morse R, Beaty B, Moon DH, Green R, Xu V, Weiss J, Sheth S, Patel S, Blumberg J, Hackman T, Lumley C, Patel S, Yarbrough W, Huff SB, Repka MC, Dagan R, Amdur RJ, Chera BS, Shen C, Chen X. Long-Term Outcomes of De-Intensified Chemoradiotherapy for Human Papillomavirus-Associated Oropharyngeal Squamous Cell Carcinoma. Int J Radiat Oncol Biol Phys 2023; 117:S123-S124. [PMID: 37784319 DOI: 10.1016/j.ijrobp.2023.06.464] [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 report long-term oncologic outcomes among patients with human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC) treated with definitive de-intensified chemoradiotherapy. MATERIALS/METHODS Major criteria for de-intensification were (1) AJCC 7th edition T0-T3, N0-N2c, M0 (AJCC 8th edition T0-T3, N0-N2, M0), (2) pathologically confirmed p16 positive, and (3) no or minimal/remote smoking history (non-mutated p53 if ≥30 pack-years). Treatment was 60 Gy intensity-modulated radiotherapy with first-choice concurrent cisplatin 30 mg/m2 once per week (alternative regimens permissible for cisplatin ineligible patients). Patients with T0-T2 N0-1 (AJCC 7th edition) were recommended 60 Gy radiation alone. Systemic therapy received included: cisplatin 30 mg/m2 (n = 122), cetuximab (n = 15), cisplatin 40 mg/m2 (n = 12), carboplatin/paclitaxel (n = 2), and radiation alone (n = 25). Kaplan Meier estimates for overall survival (OS), progression-free survival (PFS), locoregional control (LRC), and freedom from distant metastasis (FFDM) were calculated. Cox regression models were used for comparisons among subgroups. RESULTS A total 176 patients received de-intensified treatment (n = 153 prospective protocol, n = 23 off-protocol). Median follow-up was 52.6 months (range 5.3 - 102.0, 90.8% with minimum 2-year follow-up); 56.8% (n = 100) were never smokers and 43.2% (n = 76) former smokers; former smokers had median 9 pack-years smoking history (range 0.25 - 50) with 46% ≥10 pack-years. Outcomes were as follows: 2-year OS 99.4% and 5-year OS 91.8%; 2-year PFS 94.1% and 5-year PFS 84.3%; 2-year LRC 98.3% and 5-year LRC 95.8%; 2-year FFDM 95.8% and 5-year FFDM 93.2%. Median time to progression events were 21.1 months (range, 7.2 - 54.1) with 37.5% (6 of 16) of recurrences occurring after 24 months. Six total locoregional events occurred (five recurrences and one site of persistent disease), within the 60 Gy planning target volume. Twenty-three patients with T0-T2 N0-1 disease received radiation alone with 2-year PFS 92.9% (5-year 83.8%) and 2-year LRC 100% (5-year 95.2%). Outcomes for former smokers with ≥10 pack-years were comparable to patients with less or no smoking history (2-year PFS 94.1% vs 94.1%; 5-year PFS 90.6% vs 82.7%; HR 0.58, p = 0.38). Early results suggest similar oncologic outcomes among those treated off-protocol (median follow-up 25.6 months) with 1 of 23 patients experiencing locoregional recurrence. CONCLUSION Dose de-intensification of 60 Gy radiotherapy with weekly cisplatin results in favorable long-term tumor control in patients with HPV-associated OPSCC. De-intensified 60 Gy alone may be efficacious in carefully selected patients with T0-T2 N0-1 (AJCC 7th edition) disease. Inclusion of biologically favorable patients with more extensive former smoking history in de-intensification clinical trials may be warranted.
Collapse
Affiliation(s)
- R Morse
- Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, NC
| | - B Beaty
- Albert Einstein College of Medicine, Bronx, NY
| | - D H Moon
- University of Texas Southwestern Department of Radiation Oncology, Dallas, TX
| | - R Green
- University of North Carolina Hospitals, Chapel Hill, NC
| | - V Xu
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - J Weiss
- University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - S Sheth
- University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - S Patel
- University of North Carolina Hospitals, Chapel Hill, NC
| | | | - T Hackman
- Department of Otolaryngology, University of North Carolina School of Medicine, Chapel Hill, NC
| | - C Lumley
- UNC School of Medicine, Chapel Hill, NC
| | - S Patel
- UNC School of Medicine, Chapel Hill, NC
| | | | - S B Huff
- University of Carolina, Chapel Hill, NC
| | - M C Repka
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC
| | - R Dagan
- University of Florida Health Proton Therapy Institute, Jacksonville, FL
| | - R J Amdur
- University of Florida Hospitals, Gainesville, FL
| | - B S Chera
- Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - C Shen
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC
| | - X Chen
- Case Western Reserve University School of Medicine, Cleveland, OH
| |
Collapse
|
22
|
Young MD, Rohlman A, Shen C, Casey DL. The Role of Whole Abdomen and Pelvis Radiation Therapy in Desmoplastic Small Round Cell Tumor. Int J Radiat Oncol Biol Phys 2023; 117:S133. [PMID: 37784343 DOI: 10.1016/j.ijrobp.2023.06.485] [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) Desmoplastic small round cell tumor (DSRCT) is a rare entity that typically presents in adolescent and young adult men with widespread abdominopelvic disease. The benefit of whole abdomen and pelvis radiation therapy (WAPRT) after chemotherapy and maximal surgical resection is unknown. Our objective was to evaluate the oncologic benefit and toxicity of WAPRT in this rare and aggressive disease. MATERIALS/METHODS We conducteda retrospective review of patients with DSRCT treated at our institution primarily between 2018-2021. The cumulative incidence (CI) of intra-abdominopelvic failure was compared among those who received WAPRT after chemotherapy and surgery vs those who received chemotherapy and surgery alone without WAPRT utilizing Gray's method. Progression-free survival (PFS) and overall survival (OS) were also compared among patients who did and did not receive WAPRT using the Kaplan-Meier method from the date of surgery. Toxicity was graded per CTCAE v5.0 criteria. RESULTS Twenty-eight patients were included (median age 17.5 years; range 6-38 years; 78% male, 22% female). All patients received chemotherapy with VDC/IE, all but one underwent extensive tumor resection, and all but two received HIPEC at time of resection. Nineteen patients (median age 13 years) received WAPRT after surgery, while 9 patients (median age 24 years) were treated with systemic therapy and surgery alone. Patients who received WAPRT were generally treated to 30 Gy in 20 fractions utilizing intensity-modulated radiation therapy (IMRT), with a boost to gross disease to a total dose of 45-50 Gy in 9 patients. Median follow up was 20 months. The CI of intra-abdominopelvic failure at 12 and 24 months was 16% and 50% with WAPRT vs 74% and 87% without WAPRT (p = 0.003), with a median time from surgery to intra-abdominopelvic failure of 15 months after WAPRT vs 5 months without. PFS was also improved with WAP-RT (94% and 83% at 12 and 24 months) vs without WAPRT (67% and 0% at 12 and 24 months), p = 0.001. Among those who received WAPRT, patients who received a boost to gross disease had similar intra-abdominopelvic control as those who had no gross disease to boost and received WAPRT only (CI at 24 months 50% without boost vs 48% with, p = 0.95). OS did not differ between those who did and did not receive WAPRT (OS at 24 months, 88% vs 83%, p = 0.89). Most toxicities after WAPRT were mild, including grade 1-2 fatigue, nausea, and vomiting, with the exception of one patient who developed veno-occlusive disease. CONCLUSION Although limited by selection bias and short follow up, our study shows durable intra-abdominopelvic control and an improvement in PFS after WAPRT with IMRT, without an effect on OS. Additional larger, prospective investigations evaluating the value and toxicity of WAPRT for DSRCT are warranted.
Collapse
Affiliation(s)
- M D Young
- Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - A Rohlman
- University of North Carolina Chapel Hill, Chapel Hill, NC
| | - C Shen
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC
| | - D L Casey
- Memorial Sloan Kettering Cancer Center, New York, NY
| |
Collapse
|
23
|
Wang K, Shen C, Pacholke HD, Deal A, Pearlstein KA, Weiner AA, Xu V, Danquah F, Wahl DR, Jackson WC, Dess RT, Dragovic AF, Marks LB, Chera BS, Kim MM. Results of a Multi-institutional Randomized Phase 3 Trial of Parotid-Sparing Whole Brain Radiotherapy. Int J Radiat Oncol Biol Phys 2023; 117:S74-S75. [PMID: 37784566 DOI: 10.1016/j.ijrobp.2023.06.387] [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) Observational studies have reported that xerostomia is common after conventional whole brain radiotherapy (WBRT) and associated with parotid dose. In this multi-institutional, single-blind randomized controlled trial, we hypothesized that patient-reported xerostomia is reduced in patients randomized to parotid-sparing vs. standard WBRT fields. MATERIALS/METHODS Between 2018 and 2021, patients receiving conventional WBRT (30-35 Gy in 10-15 fractions) for any diagnosis were enrolled at 3 academic institutions. Patients were randomized between standard WBRT fields covering the C1 vertebra with no prospective parotid delineation (control) vs. parotid-sparing fields without C1 coverage (experimental). Patients completed the University of Michigan Xerostomia Questionnaire (Scored 0-100, higher is worse) at baseline, EndRT, 2 weeks, 1 month, 3 months, and 6 months. Patients were excluded from toxicity analyses if baseline xerostomia score was >50 or if they did not complete any post-baseline questionnaires. The primary endpoint was proportion of patients with ≥15 point absolute increase in xerostomia score from baseline to 1 month; 108 patients were needed for an 80% power to detect a 22% absolute difference (1-sided significance of 0.05). The secondary endpoint was the rate of marginal failures. RESULTS The study closed early after 56 patients were randomized. Median survival was 4.6 months. 46 patients (23 in each arm) were eligible for analysis. Mean parotid dose was 17 vs. 10 Gy in the standard vs. parotid-sparing arms, respectively. The table below shows mean xerostomia score and proportion of patients with ≥15 increase in xerostomia score at each time point. There was no difference in the proportion of patients experiencing ≥15 increase in xerostomia score at 1 month, though there was a trend toward lower xerostomia score at 1 month in patients randomized to parotid-sparing fields (p = 0.07, Table). Xerostomia rates were also significantly improved in the parotid-sparing arm at EndRT (p = 0.03), but no longer-term difference was observed with greater attrition at 3 and 6 months. On linear regression, there was a trend toward association between mean parotid dose and xerostomia score at 1 month (p = 0.06). There were no reported marginal failures in either arm. CONCLUSION Parotid-sparing without coverage of the C1 vertebra appears safe and may meaningfully reduce acute xerostomia in patients with limited life expectancy who are candidates for conventional WBRT, although the study was underpowered to detect a significant difference at 1 month.
Collapse
Affiliation(s)
- K Wang
- Department of Radiation Oncology, University of Cincinnati, Cincinnati, OH
| | - C Shen
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC
| | | | - A Deal
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - K A Pearlstein
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC
| | - A A Weiner
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC
| | - V Xu
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - F Danquah
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC
| | - D R Wahl
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
| | - W C Jackson
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
| | - R T Dess
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
| | - A F Dragovic
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
| | - L B Marks
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC
| | - B S Chera
- Medical University of South Carolina, Charleston, SC
| | - M M Kim
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
| |
Collapse
|
24
|
Hall J, Wang K, Lui KP, Darawsheh R, Shumway JW, Carey LA, Hayes KR, Lee CB, Moschos S, Sengupta S, Chaudhary R, Yogendran L, Struve TD, Vatner RE, Pater LE, Breneman JC, Weiner AA, Shen C. Safety and Efficacy of Stereotactic Radiosurgery with Concurrent Targeted Systemic Therapy for Brain Metastases. Int J Radiat Oncol Biol Phys 2023; 117:e107. [PMID: 37784639 DOI: 10.1016/j.ijrobp.2023.06.882] [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) Data describing the safety and efficacy of central nervous system (CNS)-active targeted systemic therapies in combination with stereotactic radiosurgery (SRS, 1 fraction) and/or radiotherapy (SRT, 3-5 fractions) for brain metastases are emerging but limited. We report rates of local and intracranial failure and radiation necrosis in patients receiving CNS-active targeted systemic therapy and SRS/SRT. MATERIALS/METHODS We retrospectively identified patients with intact brain metastases at two institutions from 2009-2022 who were treated with SRS/SRT and CNS-active targeted systemic therapy in any sequence. Patients were followed for a minimum of 3 months after SRS/SRT with brain MRI. Patients typically stopped the targeted agent 2-4 days prior to radiation and resumed 2-4 days after. Targeted therapies included inhibitors of ALK/ROS1 (Alectinib, Ceritinib, Crizotinib, Lorlatinib), EGFR (Afatinib, Erlotinib, Gefitinib, Osimertinib), BRAF (Dabrafenib, Encorafenib, Vemurafenib), MEK (Binimetinib, Trametinib), CDK 4/6 (Abemaciclib, Palbociclib, Ribociclib), HER2 (Afatinib, Lapatinib, Neratinib, Pertuzumab, Trastuzumab, T-DM1, T-DXd, Tucatinib), KRAS (Adagrasib and Sotorasib), PARP (Niraparib, Olaparib), VEGF(R) (Axitinib, Bevacizumab, Ramucirumab), and less-selective tyrosine (receptor) kinase inhibitors (Bosutinib, Brigatinib, Entrectinib, Lenvatinib, Pazopanib, Sorafenib, Sunitinib). Local failure (LF) and radiation necrosis were determined radiographically with clinical impression (grade 2 (symptomatic) or higher (G2+)) and compared between different systemic agents. RESULTS The study included 95 patients with 310 metastases (SRS 246, SRT 64 metastases). Most common primary histologies were non-small cell lung cancer (36% 34/95), breast cancer (28% 27/95), and melanoma (16% 15/95). Overall survival at 1 and 2 years was 80% (76/95) and 55% (52/95), respectively. Median follow-up was 16.6 (range 3-91) months. Median tumor size was 7mm (range 1-75mm). Median number of brain metastases per patient was 2.5 (range 1-12). The G2+ radiation necrosis rate was 5.8% (18/310) while the LF rate was 9.7% (30/310) per metastasis. There was no significant difference in G2+ radiation necrosis by class of targeted therapy. Sixty-two percent (59/95) of patients experienced distant intracranial failure. Median intracranial progression free survival (PFS) was 8.0 (range 0.4-61.4) months. CONCLUSION Although heterogeneous, patients treated with SRS/SRT and ongoing CNS-active targeted systemic therapies have on average >6 month intracranial PFS and little evidence of significant toxicity. We observed <6% G2+ radiation necrosis for this cohort, and no particular class of agent was associated with a significantly higher rate of G2+ radiation necrosis.
Collapse
Affiliation(s)
- J Hall
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC
| | - K Wang
- Department of Radiation Oncology, University of Cincinnati, Cincinnati, OH
| | - K P Lui
- Department of Radiation Oncology, University of Cincinnati, Cincinnati, OH
| | - R Darawsheh
- University of North Carolina, Chapel Hill, NC
| | - J W Shumway
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC
| | - L A Carey
- Division of Oncology, University of North Carolina, Chapel Hill, NC
| | - K Reeder Hayes
- Division of Oncology, University of North Carolina, Chapel Hill, NC
| | - C B Lee
- Division of Oncology, University of North Carolina, Chapel Hill, NC
| | - S Moschos
- Division of Oncology, University of North Carolina, Chapel Hill, NC
| | - S Sengupta
- Department of Neurology, University of Cincinnati, Cincinnati, OH
| | - R Chaudhary
- Division of Oncology, University of Cincinnati, Cincinnati, OH
| | - L Yogendran
- Department of Neurology, University of Cincinnati, Cincinnati, OH
| | - T D Struve
- Department of Radiation Oncology, University of Cincinnati, Cincinnati, OH
| | - R E Vatner
- Department of Radiation Oncology, University of Cincinnati, Cincinnati, OH
| | - L E Pater
- Department of Radiation Oncology, University of Cincinnati, Cincinnati, OH
| | - J C Breneman
- Department of Radiation Oncology, University of Cincinnati, Cincinnati, OH
| | - A A Weiner
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC
| | - C Shen
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC
| |
Collapse
|
25
|
Morse R, Nelson TJ, Liu HC, Williamson CW, Sacco A, Chitti BS, Henderson G, Todd J, Chen X, Gan GN, Rahn D, Sharabi A, Thompson CA, Zou J, Lominska CE, Shen C, Chera BS, Mell LK. Comparison of Standard vs. Relative Risk Models to Define Candidates for Deintensification in Locoregionally Advanced P16+ Oropharyngeal Cancer. Int J Radiat Oncol Biol Phys 2023; 117:e608-e609. [PMID: 37785830 DOI: 10.1016/j.ijrobp.2023.06.1979] [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) Various methods to identify candidates for treatment deintensification with p16+ oropharyngeal squamous cell carcinoma (OPSCC) have been used, but the optimal approach is unknown. MATERIALS/METHODS Multi-institutional cohort study of 385 patients with previously untreated p16+ OPSCC undergoing definitive radiotherapy (RT) with or without systemic therapy between 2009-2020. Chemotherapy intensity was categorized as high (bolus cisplatin and/or induction chemotherapy), medium (weekly cisplatin), or low (non-cisplatin or RT alone). Standard favorable vs. unfavorable risk was defined using NRG HN005 eligibility criteria. High vs. low relative risk (RR) group was defined using the HNCIG omega score (≥ 0.80 vs. < 0.80), which quantifies the proportion of a patient's overall event risk due to cancer. We used multivariable ordinal logistic regression to estimate effects of age (yrs), sex, performance status (PS), Charlson comorbidity index (CCI), T/N (AJCC 8th), current smoking, and pack-years (> 10 vs. ≤ 10) on treatment allocation. Effects on relative event hazards were estimated using generalized competing event regression. RESULTS Median follow-up time was 44.2 months. Chemotherapy intensity was high in 206 (54%), medium in 108 (28%), and low in 71 (18%). 280 patients (73%) were unfavorable risk and 197 (51%) were high RR. 178 patients (46%) had discordant risk classification. On univariable analysis, significant predictors of higher intensity chemotherapy (normalized odds ratio (OR)) were CCI 0-1 (OR 1.49, 95% CI: 1.23-1.79), high omega score (OR 1.46; 1.20-1.77), decreased age (OR 1.43; 1.18-1.74), and PS 0 (OR 1.22; 1.01-1.48). Controlling for CCI, higher omega score was associated with significantly higher odds of intensive chemotherapy (OR 1.35; 1.10-1.65, but unfavorable risk (HN005 ineligibility) was not (OR 1.19; 0.98-1.44). Higher omega score was also associated with significantly higher RR for cancer recurrence (Rec) vs. competing mortality (CM) events (relative HR (rHR) 1.76; 1.12-2.75), but unfavorable risk was not (rHR 1.05; 0.63-1.75). Among patients receiving cisplatin, 50 favorable risk patients (58%) had high RR; all of their event risk was due to cancer recurrence (Table). The 110 unfavorable risk patients (48%) with low omega score had significantly lower RR for cancer events compared to the high omega score group (rHR 0.49; 0.29-0.84). CONCLUSION Many patients with favorable risk p16+ OPSCC have high relative risk for cancer events, which correlates with a benefit of intensive treatment. The HNCIG omega score is a strong predictor of allocation to intensive chemotherapy and may help identify candidates for deintensification.
Collapse
Affiliation(s)
- R Morse
- Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, NC
| | - T J Nelson
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA
| | - H C Liu
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA
| | - C W Williamson
- UCSD Radiation Oncology and Applied Medicine, La Jolla, CA
| | - A Sacco
- University of California San Diego, San Diego
| | - B S Chitti
- Northwell Health Cancer Institute, Lake Success, NY
| | - G Henderson
- University of California San Diego, Department of Radiation Medicine & Applied Sciences, La Jolla, CA
| | - J Todd
- Yale University, New Haven, CT
| | - X Chen
- Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, NC
| | - G N Gan
- Department of Radiation Oncology, University of Kansas School of Medicine, Kansas City, KS
| | - D Rahn
- University of California San Diego, Department of Radiation Medicine & Applied Sciences, La Jolla, CA
| | - A Sharabi
- UC San Diego, Moores Cancer Center, Department of Radiation Medicine and Applied Sciences, La Jolla, CA
| | - C A Thompson
- University of North Carolina, Department of Epidemiology, Chapel Hill, NC
| | - J Zou
- Department of Family Medicine and Public Health and Department of Mathematics, University of California San Diego, La Jolla, CA
| | - C E Lominska
- Department of Radiation Oncology, University of Kansas School of Medicine, Kansas City, KS
| | - C Shen
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC
| | - B S Chera
- Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - L K Mell
- University of California San Diego, La Jolla, CA
| |
Collapse
|
26
|
Kotecha R, McDermott MW, Chen C, Ferreira C, Hanft S, Shen C, Wanebo J, Smith K, Wardak Z, Patel T, Chamoun R, Hoang KB, Choutka O, Rodriguez A, Shah M, Brachman DG, Campbell L, Patel S. Surgically Targeted Radiation Therapy (STaRT) for Brain Metastases: Initial Experience from a Prospective Multi-Institutional Registry. Int J Radiat Oncol Biol Phys 2023; 117:e120. [PMID: 37784668 DOI: 10.1016/j.ijrobp.2023.06.908] [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) Resection and intraoperative brachytherapy for patients with large, operable brain metastasis allows for both relief of mass effect and the delivery of radiotherapy (RT) to the resection cavity with a favorable dosimetric profile. The objective of this study was to analyze early patterns-of-care and treatment-related toxicity outcomes for brain metastasis patients treated with surgically targeted radiation therapy (STaRT) using a novel brachytherapy carrier. MATERIALS/METHODS Patients with brain metastasis, de novo and recurrent disease, who enrolled onto a prospective multi-institutional observational study (NCT04427384) were the subject of this analysis. Patients underwent resection and immediate implantation of bioresorbable, conformable, 20 mm x 20 mm x 4 mm collagen tile brachytherapy device(s) containing four uniform-intensity Cesium-131 sources. Toxicities were categorized using the CTCAE v5.0 adverse event (AE) criteria. RESULTS From 10/2020 to 01/2023, 13 participating sites enrolled and treated 48 patients with 51 metastases (13 with de novo and 35 patients with recurrent brain metastases), and 3 patients had 2 lesions implanted at the same procedure. Median age was 61 years (range: 28-80), 52% were female, and the most common primary types were lung (56%) and breast (13%). The median maximum pre-operative dimension was 3.4 cm (range: 1.7-5.7) and median pre-operative tumor volume 13.7cm3 (range: 1.7-132). 64% had received prior RT with a median time from last RT to STaRT of 14.6 months range: 3.5-57.3). Median KPS at screening was 80 (range: 50-100), and remained stable at post op visit (80, range: 50-100), and at 3-months following treatment (80, range 50-100), respectively (p>0.05). The median time for implantation was 3 minutes (range: 0.4-30). At a median follow-up of 4 months (range: <1-18), no patient experienced a radiation-attributed AE, and only 1 attributable Gr >3 AE was noted (Gr 5 intracerebral hemorrhage deemed probably related to surgery and unrelated to the implanted device). CONCLUSION Early results from this prospective multi-center trial demonstrate the feasibility and safety of STaRT. The lack of radiation-related AE, even with short follow-up, is intriguing given the relatively large lesion size and proportion of patients treated for recurrent, previously irradiated disease. Additional follow-up will provide data on tumor control outcomes and radiation necrosis rates using this novel technique.
Collapse
Affiliation(s)
- R Kotecha
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL
| | - M W McDermott
- Department of Neurosurgery, Miami Neuroscience Institute, Baptist Health South Florida, Miami, FL
| | - C Chen
- Department of Neurosurgery, University of Minnesota Medical School, Minneapolis, MN
| | - C Ferreira
- Department of Radiation Oncology, University of Minnesota Medical School, Minneapolis, MN
| | - S Hanft
- Westchester Medical Center, Valhalla, NY
| | - C Shen
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC
| | - J Wanebo
- Honor Health Research Institute, Scottsdale, AZ
| | - K Smith
- Barrow Neurological Institute, Phoenix, AZ
| | - Z Wardak
- University of Texas Southwestern Medical Center, Dallas, TX
| | - T Patel
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - R Chamoun
- University of Kansas Medical Center, Kansas City, KS
| | - K B Hoang
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA
| | - O Choutka
- St. Alphonsus Regional Medical Center, Boise, ID
| | - A Rodriguez
- University of Arkansas for Medical Sciences, Director of Neurosurgical Oncology, Little Rock, AR
| | - M Shah
- Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, IN; Indiana University Health North Hospital, Indianapolis, IN
| | | | | | - S Patel
- GT Medical Technologies, Tempe, AZ
| |
Collapse
|
27
|
Yoo Y, Gibson E, Zhao G, Sandu A, Re T, Das J, Hesheng W, Kim MM, Shen C, Lee YZ, Kondziolka D, Ibrahim M, Lian J, Jain R, Zhu T, Parmar H, Comaniciu D, Balter J, Cao Y. An Automated Brain Metastasis Detection and Segmentation System from MRI with a Large Multi-Institutional Dataset. Int J Radiat Oncol Biol Phys 2023; 117:S88-S89. [PMID: 37784596 DOI: 10.1016/j.ijrobp.2023.06.414] [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) Developments of automated systems for brain metastasis (BM) detection and segmentation from MRI for assisting early detection and stereotactic radiosurgery (SRS) have been reported but most based upon relatively small datasets from single institutes. This work aims to develop and evaluate a system using a large multi-institutional dataset, and to improve both identification of small/subtle BMs and segmentation accuracy of large BMs. MATERIALS/METHODS A 3D U-Net system was trained and evaluated to detect and segment intraparenchymal BMs with a size > 2mm using 1856 MRI volumes from 1791 patients treated with SRS from seven institutions (1539 volumes for training, 183 for validation, and 134 for testing). All patients had 3D post-Gd T1w MRI scans pre-SRS. Gross tumor volumes (GTVs) of BMs for SRS were curated by each institute first. Then, additional efforts were spent to create GTVs for the untreated and/or uncontoured BMs, including central reviews by two radiologists, to improve accuracy of ground truth. The training dataset was augmented with synthetic BMs of 3773 MRIs using a 3D generative pipeline. Our system consists of two U-Nets with one using small 3D patches dedicated for detecting small BMs and another using large 3D patches for segmenting large BMs, and a random-forest based fusion module for combining the two network outputs. The first U-Net was trained with 3D patches containing at least one BM < 0.1 cm3. For detection performance, we measured BM-level sensitivity and case-level false-positive (FP) rate. For segmentation performance, we measured BM-level Dice similarity coefficient (DSC) and 95-percentile Hausdorff distance (HD95). We also stratified performances based upon BM sizes. RESULTS For 739 BMs in the 134 testing cases, the overall lesion-level sensitivity was 0.870 with an average case-level FP of 1.34±1.92 (95% CI: 1.02-1.67). The sensitivity was >0.969 for the BMs >0.1 cm3, but dropped to 0.755 for the BMs < 0.1 cm3 (Table 1). The average DSC and HD95 for all detected BMs were 0.786 and 1.35mm. The worse performance for BMs > 20 cm3 was caused by a case with 83 cm3 GTV and artifacts in the MRI volume. CONCLUSION We achieved excellent detection sensitivity and segmentation accuracy for BMs > 0.1 cm3, and promising performance for small BMs (<0.1cm3) with a controlled FP rate using a large multi-institutional dataset. Clinical utility for assisting early detection and SRS planning will be investigated. Table 1: Per-lesion detection and segmentation performance stratified by individual BM size. N is the number of BMs in each category.
Collapse
Affiliation(s)
- Y Yoo
- Siemens Healthineers, Princeton, NJ
| | - E Gibson
- Siemens Healthineers, Princeton, NJ
| | - G Zhao
- Siemens Healthineers, Princeton, NJ
| | - A Sandu
- Siemens Healthineers, Princeton, NJ
| | - T Re
- Siemens Healthineers, Princeton, NJ
| | - J Das
- Siemens Healthineers, Princeton, NJ
| | | | - M M Kim
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
| | - C Shen
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC
| | - Y Z Lee
- University of North Carolina, Chapel Hill, NC
| | - D Kondziolka
- Department of Neurosurgery, NYU Langone Health, New York, NY
| | - M Ibrahim
- University of Michigan, Ann Arbor, MI
| | - J Lian
- University of North Carolina, Chapel Hill, NC
| | - R Jain
- New York University, New York, NY
| | - T Zhu
- Washington University, St. Louis, MO
| | - H Parmar
- Department of Radiology, University of Michigan, Ann Arbor, MI
| | | | - J Balter
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
| | - Y Cao
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
| |
Collapse
|
28
|
Fried DV, Ahmidouch M, Shen C, Das SK, Marks LB, Chera BS. Identifying a Dose Constraint for the Parotid Ducts: Impact on Patient Reported Xerostomia and Comparison to Conventional Parotid Gland Mean Dose Sparing. Int J Radiat Oncol Biol Phys 2023; 117:S100. [PMID: 37784267 DOI: 10.1016/j.ijrobp.2023.06.053] [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) (1) Identify a dose constraint for the parotid ducts to reduce patient reported xerostomia and compare effectiveness to QUANTEC constraint. (2) Determine if conventionally planned patients meet this constraint by using atlas-based duct segmentation. MATERIALS/METHODS (1) 38 patients with oropharyngeal squamous cell carcinoma (OPSCC) were treated prospectively on trial with MRI sialography guided parotid duct sparing radiation therapy (parotid duct sparing cohort). These patients were compared to a historical cohort of 89 similar patients treated with conventional parotid gland mean dose sparing for salivary gland dosimetry and patient reported xerostomia (PRO-CTCAE ≥ Moderate). (2) A contour atlas comprised of 24 patients with MRI sialograms was created. Atlas-based segmentation was generated on the remaining 14 patients with MRI sialograms to assess for contour accuracy. Atlas-based parotid duct contours were generated on 111 patients treated with conventional parotid gland mean dose sparing to facilitate a dosimetric comparison to the parotid duct sparing cohort. RESULTS (1) In the parotid duct sparing cohort, patients whose parotid ducts (bilateral) were planned for a mean dose <14 Gy reported significantly (p<0.01) lower rates of xerostomia compared to patients whose ducts were planned to receive >14 Gy (26% (5/19) versus 86% (12/14) at 6 months post-RT and 22% (4/18) versus 73% (8/11) at 12 months post-RT). This improvement compares favorably to the QUANTEC constraint of bilateral parotid glands < 25 Gy (see Table). (2) The atlas-based duct contours were found to have a mean distance-to-agreement of 5mm and an average absolute dose difference of 4.5 Gy compared to the MRI sialography defined duct contours. The average duct dose for those undergoing MRI sialography guided duct sparing was found to be 13.5 Gy compared to an estimated (via atlas-based segmentation) 22.3 Gy for those receiving conventional parotid gland mean dose sparing (p < 0.01). 20% (22/111) patients receiving conventional parotid gland mean dose sparing met the 14 Gy parotid duct constraint versus 60% of patients undergoing MRI sialography guided parotid duct sparing. CONCLUSION Parotid duct sparing (parotid duct dose <14 Gy) was both more effective (∼50% [76% to 26%] absolute xerostomia reduction at 6mo and ∼24% [46% to 22%] absolute xerostomia reduction at 12 mo) and more achievable (∼60% of patients vs ∼35% patients) than mean dose parotid gland sparing per QUANTEC constraint. Atlas-based segmentation estimated that MRI sialography guided parotid duct sparing reduced the parotid duct dose by 9 Gy and that only 20% of patients met the parotid duct dose constraint (<14 Gy) with conventional parotid gland mean dose sparing.
Collapse
Affiliation(s)
- D V Fried
- Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - M Ahmidouch
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - C Shen
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC
| | - S K Das
- Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - L B Marks
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC
| | - B S Chera
- Department of Radiation Oncology, Medical University of South Carolina, Charleston, SC
| |
Collapse
|
29
|
Zarabi H, Helis CA, Russell G, Huang J, Liu W, Soltys SG, Mendoza M, Braunstein SE, Salans MA, Wang TJC, Gallitto M, Shi W, Cappelli L, Shen C, Young MD, Mignano JE, Halasz LM, Barbour AB, Masters AH, Chan MD. Multi-Institutional Report of Re-Irradiation for Recurrent High-Grade Glioma. Int J Radiat Oncol Biol Phys 2023; 117:S85-S86. [PMID: 37784590 DOI: 10.1016/j.ijrobp.2023.06.408] [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) Significant heterogeneity exists with regards to prior published reports of re-irradiation (re-RT) in patients with recurrent high grade glioma (HGG). A multi-institutional database of 10 academic centers across the United States was created to analyze prognostic outcomes for re-RT for recurrent HGG, which included WHO Grade III and Grade IV tumors. MATERIALS/METHODS Patients with HGG who had initially received standard radiotherapy (RT) and were subsequently treated with a course of re-RT at recurrence were included in the study. Factors assessed to delineate a significant association with overall survival (OS) and toxicity included age, KPS, number of relapses, dose, use of bevacizumab (BEV) or temozolomide (TMZ), time from prior RT, histology, RT target, re-RT target> 5cm and extent of resection, and MGMT methylation status. The Kaplan-Meier Method was used to estimate OS. Cox proportional hazards regression models were used to identify factors associated with OS. Toxicity outcomes were assessed using logistic regression. Significance was assumed if p<0.05. Data management and decision management software were used for all analyses. RESULTS Between 2001 and 2022, 280 patients from 10 academic institutions were treated with re-RT for diagnosis of recurrent HGG. 133 patients (71.1%) had a histologic glioblastoma (GBM) at the time of re-RT, with the remainder having Grade 3 gliomas. Median dose delivered at re-RT was 47 Gy BED10 (IQR 47 - 53 Gy BED10), with the most common regimen being 35 Gy in 10 fractions. 83 patients (56%) had GTV greater than 5 cm treated with re-RT. 183 patients (79%) received concurrent systemic therapy, including 95 (41%) who received concurrent TMZ and 86 (45%) who received concurrent BEV. Median OS for the entire cohort was 10 months. Increasing dose at re-RT was associated with improved OS (OR 0.80 95% CI 0.67-0.95, p = 0.10 per 10 Gy BED10), as was dose greater than 47 Gy BED10, which is equivalent to 35 Gy in 10 fractions (OR 0.70, 95% CI 0.54-0.91). Concurrent TMZ was also associated with improved OS (OR 0.68, 95% CI 0.46-0.83, p < 0.01). 32/143 (22%) patients evaluable for toxicity experienced Grade 2 or greater adverse radiation effect (ARE). Use of BEV was associated with decreased toxicity (OR 0.45, 95% CI 0.21-0.98, p = 0.05). Dose at re-RT (OR 1.07 per 10 Gy BED10, p = 0.78), a GTV > 5cm (OR 1.39, p = 0.44), and the use of concurrent TMZ (OR 1.90, p = 0.10) were not associated with Grade 2 or greater ARE. CONCLUSION Higher dose of re-RT and use of concurrent TMZ led to improved OS in recurrent HGG patients without an associated increased rate of ARE. Use of BEV decreased the likelihood of Grade 2 or greater ARE in the re-RT setting for these recurrent HGG patients.
Collapse
Affiliation(s)
- H Zarabi
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC
| | - C A Helis
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC
| | - G Russell
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC
| | - J Huang
- Washington University School of Medicine in St. Louis, Department of Radiation Oncology, St. Louis, MO
| | - W Liu
- University of Iowa, Iowa City, IA
| | - S G Soltys
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - M Mendoza
- Department of Radiation Oncology, Stanford University School of Medicine, Palo Alto, CA
| | - S E Braunstein
- University of California San Francisco, Department of Radiation Oncology, San Francisco, CA
| | - M A Salans
- University of California San Francisco, San Francisco, CA
| | | | - M Gallitto
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, NY
| | - W Shi
- Thomas Jefferson University Hospital, Philadelphia, PA
| | - L Cappelli
- Department of Radiation Oncology, Thomas Jefferson University Hospital, Philadelphia, PA
| | - C Shen
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC
| | - M D Young
- Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - J E Mignano
- Tufts Medical Center, Department of Radiation Oncology, Boston, MA
| | - L M Halasz
- Department of Radiation Oncology, University of Washington/ Fred Hutchinson Cancer Center, Seattle, WA
| | | | | | - M D Chan
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC
| |
Collapse
|
30
|
Steele EM, Payne MM, Weiner AA, Casey DL, Shen C. Factors Associated with Short Interval from Treatment to Death in Patients Treated with Stereotactic Body Radiotherapy for Lung Metastases: Experience at a Large Academic Facility. Int J Radiat Oncol Biol Phys 2023; 117:e152. [PMID: 37784737 DOI: 10.1016/j.ijrobp.2023.06.973] [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) Stereotactic body radiotherapy (SBRT) is increasingly used to treat patients with lung metastases, as several studies have demonstrated a survival benefit in patients with oligometastatic disease, while in other cases it is used for palliation as in the re-irradiation setting. With increasing use, we queried whether SBRT is given more frequently toward the end of life for patients with lung metastases and assessed factors associated with a shorter interval from SBRT to death. MATERIALS/METHODS A sample of patients who received stereotactic body radiation therapy (SBRT) to lung metastases between 2014-2022 at a single academic institution were identified. Medical records were reviewed for patient demographic, disease, and treatment details, including age, sex, race, insurance status, Karnofsky performance status (KPS), and time from SBRT to death. Descriptive statistics including chi-square and t-test analyses were used to compare patients who did versus did not die within 180 days of completion of SBRT. RESULTS A total of 81 episodes of SBRT for lung metastases were identified. Of these, median age was 68 years (range 22-86), 82.7% had KPS >70, a majority had Medicare/Medicaid (61.7%, 50/81) or private insurance (33.3%, 27/81), and 63% were male. Only 9 of the 81 patients (11.1%) died within 180 days of SBRT completion. Death within 180 days occurred in 7.3% of treatments prior to 2018 compared to 15.0% of more recent treatments, but this difference was not statistically significant (p = 0.27; Table 1). Non-White race, KPS ≤70, and lack of insurance were all associated with increased likelihood of death within 180 days of SBRT (p<0.001 all comparisons). CONCLUSION Few patients treated with SBRT for lung metastases in our series died within 180 days of SBRT completion, and there did not appear to be a significant increase in 180-day mortality post-SBRT in recent years. While limited by the small number of events, race, KPS, and insurance status were significantly associated with likelihood of death within 180 days of SBRT. Additional work is needed to better appreciate what patients may benefit from SBRT for lung metastases. Table 1: Characteristics of patients that did versus did not die within 180 days of SBRT for lung metastases.
Collapse
Affiliation(s)
- E M Steele
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC
| | - M M Payne
- University of North Carolina, Chapel Hill, NC
| | - A A Weiner
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC
| | - D L Casey
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC
| | - C Shen
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC
| |
Collapse
|
31
|
Hall J, Dance MJ, Nguyen L, Repka MC, Chen X, Shen C. Hippocampal-Sparing Radiotherapy in Primary Sinonasal and Cutaneous Head and Neck Malignancies: A Feasibility Study. Int J Radiat Oncol Biol Phys 2023; 117:e586-e587. [PMID: 37785776 DOI: 10.1016/j.ijrobp.2023.06.1931] [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) Patients with primary sinonasal and cutaneous head and neck (H&N) malignancies often receive meaningful hippocampal doses, but the hippocampus is not a classic avoidance structure in radiation planning of these primary sites. This series characterizes the feasibility and tradeoffs of hippocampal-sparing radiotherapy (HSRT) for patients with primary sinonasal and cutaneous H&N malignancies. MATERIALS/METHODS We retrospectively identified patients at a single institution treated definitively for primary sinonasal or cutaneous malignancies of the H&N. Each patient received (chemo)radiation and all received clinically-significant radiation dose to one or both hippocampi. We created new HSRT plans for each patient with intensity-modulated radiotherapy using original target and organ-at-risk (OAR) volumes. Hippocampi were contoured based on Radiation Therapy Oncology Group guidelines. Absolute and relative differences in radiation dose to the hippocampi, planning target volumes (PTV), and OARs were recorded. We used paired-samples t-tests to compare hippocampal and PTV dosimetric measures with and without HSRT. RESULTS Thirty-seven patients were included (22 sinonasal, 11 cutaneous H&N, and 4 parotid primary tumors). Median prescription dose was 6600cGy (range: 5000-7440cGy). The most common fractionation regimens were 200cGy/fraction daily (51%, 19/37 patients) and 120cGy/fraction twice daily (41%, 15/37 patients). There were significant decreases in hippocampal Dmax and D100% using HSRT without compromising PTV coverage (Table 1). HSRT resulted in a relative increase of mean lacrimal gland dose by an average of 3.8%, optic chiasm Dmax by 1.3%, and whole brain Dmax of 1.2%. However, other OAR doses were lower with HSRT, including parotid gland mean dose, lens Dmax, optic nerve Dmax, cochlea mean dose, brainstem Dmax, and whole brain mean dose. CONCLUSION HSRT is feasible and results in meaningful radiation dose reduction to the hippocampi without reducing PTV coverage or increasing dose to other OARs. The hippocampi should be regularly included as avoidance structures when treating primary sinonasal and cutaneous H&N tumors with radiation. We suggest target hippocampal constraints of Dmax < 1600cGy and D100% < 500cGy when feasible (without compromising PTV coverage). The clinical significance of HSRT in patients with primary H&N tumors should be investigated prospectively.
Collapse
Affiliation(s)
- J Hall
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC
| | - M J Dance
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC
| | - L Nguyen
- North Carolina School of Science and Mathematics, Durham, NC
| | - M C Repka
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC
| | - X Chen
- Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, NC
| | - C Shen
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC
| |
Collapse
|
32
|
Morse R, Stepp WH, Oldan J, Huang BY, Tasoulas J, Chera BS, Chen X, Hackman T, Shen C. Definitive Chemoradiation Treatment Response Evaluation Using NI-RADS and ctHPVDNA for HPV-Associated Oropharyngeal Squamous Cell Carcinoma. Int J Radiat Oncol Biol Phys 2023; 117:S150-S151. [PMID: 37784382 DOI: 10.1016/j.ijrobp.2023.06.570] [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 compare the evaluation of treatment response among patients with human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC) treated with definitive (chemo)radiotherapy (CRT). MATERIALS/METHODS Patients with locally advanced HPV-associated OPSCC treated with definitive radiotherapy (RT) or CRT from 2019 to 2022 at a single institution were reviewed. Patients underwent standard 3-month post-CRT positron emission tomography/computed tomography (PET/CT) scan with or without contrast enhanced CT (CECT) of the head and neck. Plasma circulating tumor HPV DNA (ctHPVDNA) was collected from 2-8 months post-CRT. Equivocal findings on post-CRT imaging prompted repeat evaluation. Imaging response was assessed via NI-RADS (Neck Imaging Reporting and Data System) risk classification and independently reviewed by two board certified radiologists, both blinded to outcomes and ctHPVDNA values. RESULTS Our cohort of 52 patients included: 87% males; median age 61.5; 63% never smokers, 31% former smokers, 6% current smokers; 44% tonsil primary, 46% base of tongue; 4% T0, 25% T1, 40% T2, 12% T3, 17% T4; 6% N0, 15% N1, 2% N2a, 44% N2b, 25% N2c, 8% N3 (AJCC 7th edition). Concurrent systemic therapy was received in 90%. During this period 71 PET/CTs and 15 CECTs were reviewed for treatment response evaluation; 44% (23/52) patients required additional imaging for equivocal findings; 62 ctHPVDNA blood samples were co-analyzed for treatment evaluation. The highest risk classification score between mucosa, primary, and/or neck site was: 42% NI-RADS 1, 48% NI-RADS 2, and 10% NI-RADS 3. Only patients with locoregional disease recurrence/progression were included for evaluation comparison between imaging and circulating biomarkers. No cancer events occurred without imaging and/or ctHPVDNA detection. Patients with NI-RADS score ≥2 during first post-CRT imaging evaluation more frequently underwent additional imaging (70% vs 30%, p<0.001). NI-RADS risk classification suggested 5 locoregional events (2 true positives, 3 false positives) resulting in 100% sensitivity, 94% specificity, 40% positive predictive value (PPV), and 100% negative predictive value (NPV). Circulating tumor HPV-DNA identified 2 locoregional events (2 true positives, 0 false positives) resulting in 100% sensitivity, 100% specificity, 100% PPV, and 100% NPV. Salvage operations were performed in 2 of 3 patients with false positive disease by NI-RADS classification without any evidence of cancer on final pathology. CONCLUSION While limited by the small number of recurrence events in this cohort, ctHPVDNA for HPV-associated OPSCC in conjunction with post-treatment imaging evaluation may limit the need for repeat imaging and unwarranted salvage operations that increase patient worry, morbidity, and financial toxicity. Additional prospective study is warranted.
Collapse
Affiliation(s)
- R Morse
- Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, NC
| | - W H Stepp
- Department of Otolaryngology, University of North Carolina School of Medicine, Chapel Hill, NC
| | - J Oldan
- Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, NC
| | - B Y Huang
- Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, NC
| | - J Tasoulas
- Department of Otolaryngology, University of North Carolina School of Medicine, Chapel Hill, NC
| | - B S Chera
- Department of Radiation Oncology, Medical University of South Carolina, Charleston, SC
| | - X Chen
- Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, NC
| | - T Hackman
- Department of Otolaryngology, University of North Carolina School of Medicine, Chapel Hill, NC
| | - C Shen
- Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, NC
| |
Collapse
|
33
|
Holcomb RM, Zil-E-Ali A, Gonzalez R, Dowling RD, Shen C, Aziz F. Depression Is Associated With Non-Home Discharge After Coronary Artery Bypass Graft. J Surg Res 2023; 290:232-240. [PMID: 37301175 DOI: 10.1016/j.jss.2023.05.002] [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: 07/10/2022] [Revised: 04/24/2023] [Accepted: 05/02/2023] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Depression is disproportionately high in patients with coronary artery disease and has been associated with adverse outcomes following coronary artery bypass graft (CABG). One quality metric, non-home discharge (NHD), can have substantial implications for patients and health care resource utilization. Depression increases the risk of NHD after many operations, but it has not been studied after CABG. We hypothesized that a history of depression would be associated with an increased risk of NHD following CABG. METHODS CABG cases were identified from the 2018 National Inpatient Sample using ICD-10 codes. Depression, demographic data, comorbidities, length of stay (LOS), rate of NHD were analyzed using appropriate statistical tests where a P-value < 0.05 was defined as statistically significant. Adjusted multivariable logistic regression models were used to assess independent association between depression and NHD as well as LOS while controlling for confounders. RESULTS There were 31,309 patients, of which 2743 (8.8%) had depression. Depressed patients were younger, females, in a lower income quartile, and more medically complex. They also demonstrated more frequent NHD and prolonged LOS. After adjusted multivariable analysis, depressed patients had a 70% increased odds of NHD (adjusted odds ratio: 1.70 [1.52-1.89] P < 0.001) and a 24% increased odds of prolonged LOS (AOR: 1.24 [1.12-1.38] P < 0.001). CONCLUSIONS From a national sample, depressed patients were associated with more frequent NHD following CABG. To our knowledge, this is the first study to demonstrate this, and it highlights the need for improved preoperative identification in order to improve risk stratification and timely allocation of discharge services.
Collapse
Affiliation(s)
- Ryan M Holcomb
- Department of Surgery, Pennsylvania State University College of Medicine, Hershey, Pennsylvania.
| | - Ahsan Zil-E-Ali
- Division of Vascular Surgery, Department of Surgery, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Robert Gonzalez
- Department of Psychiatry and Behavioral Health, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Robert D Dowling
- Division of Cardiac Surgery, Department of Surgery, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Chan Shen
- Division of Outcomes Research and Quality, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Faisal Aziz
- Division of Vascular Surgery, Department of Surgery, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| |
Collapse
|
34
|
Greene AC, Wong WG, Perez Holguin RA, Patel A, Pameijer CR, Shen C. ASO Visual Abstract: The Association of Guideline-Concordant Sentinel Lymph Node Biopsy for Melanoma at Minority-Serving Hospitals. Ann Surg Oncol 2023; 30:5772-5773. [PMID: 37118615 DOI: 10.1245/s10434-023-13491-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Affiliation(s)
- Alicia C Greene
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, USA
| | - William G Wong
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, USA
| | - Rolfy A Perez Holguin
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, USA
| | - Akshilkumar Patel
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, USA
| | - Colette R Pameijer
- Division of Surgical Oncology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Chan Shen
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, USA.
- Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, Hershey, PA, USA.
| |
Collapse
|
35
|
Ba DM, Hu A, Shen C, Leslie DL, Chinchilli VM, Rogers AM, Al-Shaar L. Trends and predictors of nutritional deficiencies after bariatric surgeries: analysis of real-world data. Surg Obes Relat Dis 2023; 19:935-943. [PMID: 37005153 DOI: 10.1016/j.soard.2023.02.013] [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: 09/17/2022] [Revised: 01/30/2023] [Accepted: 02/15/2023] [Indexed: 02/25/2023]
Abstract
BACKGROUND Bariatric surgery (BS) can lead to postoperative nutritional deficiencies (NDs) due to restrictive and malabsorptive mechanisms, but there is limited literature quantifying NDs' prevalence over time and their predictors among patients undergoing BS. OBJECTIVE To characterize time trends and predictors of postoperative NDs. SETTING This retrospective cohort study used the U.S. IBM MarketScan commercial claims database (2005-2019) to include adults who underwent BS with continuous enrollment. METHODS BS included Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), adjustable gastric band (AGB), and biliopancreatic diversion with duodenal switch. NDs included protein malnutrition, deficiencies in vitamins D and B12, and anemia that may be related to NDs. Logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) of NDs across BS types after adjusting for other patient factors. RESULTS Within 83,635 patients (mean age [SD], 44.5 [9.5] yr; 78% female patients), 38.7%, 32.9%, and 28% underwent RYGB, SG, and AGB, respectively. Age-adjusted prevalence of any NDs within 1, 2, and 3 years after BS ranged from 23%, 34%, and 42%, respectively (in 2006) to 44%, 54%, and 61%, respectively (in 2016). Relative to the AGB group, the adjusted OR of any 3-year postoperative NDs was 3.00 (95% CI, 2.89-3.11) for the RYGB group and 2.42 (95% CI, 2.33-2.51) for the SG group. CONCLUSIONS RYGB and SG were associated with 2.4- to 3.0-fold odds of developing 3-year postoperative NDs compared with AGB, independent of baseline ND status. Pre- and postoperative nutritional assessments are recommended for all patients undergoing BS to optimize postoperative outcomes.
Collapse
Affiliation(s)
- Djibril M Ba
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania.
| | - Antoinette Hu
- Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Chan Shen
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania; Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Douglas L Leslie
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - Vernon M Chinchilli
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - Ann M Rogers
- Department of Surgery - Division of Minimally Invasive and Bariatric Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Laila Al-Shaar
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania.
| |
Collapse
|
36
|
Chen YJ, Qin Y, Yu H, Zhu Z, Shen C, Lu Y, Cheng TT, Zhang N, Gu SJ, Zhou JY, Wu M, Su J. [A prospective cohort study of long-term fasting blood glucose variability and risk of mortality in patients with type 2 diabetes]. Zhonghua Liu Xing Bing Xue Za Zhi 2023; 44:1099-1105. [PMID: 37482713 DOI: 10.3760/cma.j.cn112338-20221226-01084] [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] [Grants] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
Objective: To investigate the association between long-term fasting blood glucose (FPG) variability and all-cause mortality in patients with type 2 diabetes. Methods: A total of 7 174 type 2 diabetic patients included in National Basic Public Health Service Program in Changshu of Jiangsu Province were recruited as participants. Long-term glucose variability was assessed using standard deviation (SD), coefficient of variation (CV), average real variability (ARV), and variability independent of the mean (VIM) across FPG measurements at the more than three visits. Death information were mainly obtained from the death registry system in Jiangsu. Then Cox proportional hazards regression models were used to estimate the associations of four variability indicators and all-cause mortality's hazard ratios (HRs) and their 95%CIs. Results: Among 55 058.50 person-years of the follow-up, the mean follow-up time was 7.67 years, and 898 deaths occurred during the follow-up period. After adjustment, compared with T1 group, the Cox regression model showed that HRs of T3 group in SD, CV, ARV and VIM were 1.24 (95%CI: 1.03-1.49), 1.20 (95%CI: 1.01-1.43), 1.28 (95%CI: 1.07-1.55) and 1.20 (95%CI:1.01-1.41), respectively. HRs of per 1 SD higher SD, CV, ARV and VIM were 1.13 (95%CI: 1.06-1.21), 1.08 (95%CI: 1.01-1.15), 1.05 (95%CI: 1.00-1.12) and 1.09 (95%CI: 1.02-1.16) for all-cause mortality, respectively. In the stratified analysis, age, gender, hypoglycemic agent and insulin uses had no effect on the above associations (all P for interaction >0.05). Conclusion: Long-term FPG glycemic variability was positively associated with the risk of all-cause mortality in type 2 diabetes patients.
Collapse
Affiliation(s)
- Y J Chen
- Department of Non-communicable Chronic Disease Prevention, Nanjing Municipal Center for Disease Control and Prevention, Nanjing 210003, China
| | - Y Qin
- Department of Non-communicable Chronic Disease Control, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China
| | - H Yu
- Department of Non-communicable Chronic Disease Control, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China
| | - Z Zhu
- Department of Non-communicable Chronic Disease Control, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China
| | - C Shen
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Y Lu
- Department of Non-communicable Chronic Disease Prevention, Suzhou Prefectural Center for Disease Control and Prevention, Suzhou 215004, China
| | - T T Cheng
- Department of Infectious Disease Control Division, Suzhou National New & Hi-Tech Industrial Development Zone (Huqiu District) Center for Disease Control and Prevention, Suzhou 215163, China
| | - N Zhang
- Changshu County Center for Disease Control and Prevention, Changshu 215500, China
| | - S J Gu
- Department of Non-communicable Chronic Disease Prevention, Changshu County Center for Disease Control and Prevention, Changshu 215500, China
| | - J Y Zhou
- Department of Non-communicable Chronic Disease Control, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China
| | - M Wu
- Department of Non-communicable Chronic Disease Control, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China
| | - J Su
- Department of Non-communicable Chronic Disease Control, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China
| |
Collapse
|
37
|
Shen C, Ying XR, Wu GF, Xia D. [Three cases of primary small cell neuroendocrine carcinoma of the upper urinary tract and review of the literature]. Zhonghua Zhong Liu Za Zhi 2023; 45:525-529. [PMID: 37355472 DOI: 10.3760/cma.j.cn112152-20220331-00221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/26/2023]
Affiliation(s)
- C Shen
- Department of Urology, Shaoxing People's Hospital, Shaoxing 312000, China
| | - X R Ying
- Department of Urology, Shaoxing People's Hospital, Shaoxing 312000, China
| | - G F Wu
- Department of Urology, Shaoxing People's Hospital, Shaoxing 312000, China
| | - D Xia
- Department of Urology, the First Affiliated Hospital of Zhejiang University, Hangzhou 310000, China
| |
Collapse
|
38
|
Liu JH, Xie HK, Su J, Zhu Z, Pan EC, Lu Y, Wan FP, Yan QY, Zhang N, Gu SJ, Wu M, Zhou JY, Shen C. [The distribution of blood pressure and associated factors of the elderly with type 2 diabetes in Jiangsu Province]. Zhonghua Yu Fang Yi Xue Za Zhi 2023; 57:614-625. [PMID: 37165808 DOI: 10.3760/cma.j.cn112150-20221111-01101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Objective: To investigate the distribution of blood pressure and analyze the associated factors of blood pressure of the elderly with type 2 diabetes in Jiangsu Province. Methods: The elderly over 60 years old participants with type 2 diabetes in the communities of Huai'an City and Changshu City, Jiangsu Province were selected in this study. They were divided into two groups: taking antihypertensive drugs and not taking antihypertensive drugs. The demographic characteristics, such as age and sex, and relevant factors were collected by questionnaire. The systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured by physical examination. The percentile of SBP and DBP in each age group of men and women were described. The kernel density estimation curve was used to show the blood pressure distribution. The trend of blood pressure with age was fitted by locally weighted regression. The logistic regression model was used to analyze relevant factors of blood pressure. Results: A total of 12 949 participants were included in this study, including 7 775 patients in the antihypertensive drug group and 5 174 patients in the group without antihypertensive drugs. The SBP of participants was concentrated at 140-160 mmHg, and their DBP was concentrated at 75-85 mmHg. There were significant differences in the distribution of blood pressure among the subgroups of body mass index (BMI) and rural areas whether taking antihypertensive drugs and not. For participants aged under 80 years old, the SBP showed an increasing trend with age and the DBP showed a decreasing trend with age. Age, BMI ≥24 kg/m2, fasting blood glucose ≥7.0 mmol/L, living in rural areas and no smoking were influencing factors of the elevated SBP; BMI ≥24 kg/m2, male, living in rural areas, no smoking, drinking alcohol and not receiving drug hypoglycemic treatment were influencing factors of the elevated DBP. Conclusion: The SBP of older diabetic adults in Jiangsu Province is at a high level, and the distribution of blood pressure is significantly different between men and women in taking antihypertensive drugs group. The SBP presents a rising trend and the DBP is decreasing at the age of 60-80 years. The blood pressure level of this population are mainly affected by age, BMI, urban and rural areas, smoking.
Collapse
Affiliation(s)
- J H Liu
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - H K Xie
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - J Su
- Department of Non-communicable Chronic Disease Control, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China
| | - Z Zhu
- Department of Non-communicable Chronic Disease Control, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China
| | - E C Pan
- Center for Disease Control and Prevention of Huai'an City, Huai'an 223002, China
| | - Y Lu
- Department of Non-communicable Chronic Disease Control, Center for Disease Control and Prevention of Suzhou City, Suzhou 215004, China
| | - F P Wan
- Department of Non-communicable Chronic Disease Control, Center for Disease Control and Prevention of Qingjiangpu District in Huai'an City, Huai'an 223021, China
| | - Q Y Yan
- Department of Non-communicable Chronic Disease Control, Center for Disease Control and Prevention of Huai'an District in Huai'an City, Huai'an 223229, China
| | - N Zhang
- Center for Disease Control and Prevention of Changshu and Suzhou City, Suzhou 215500, China
| | - S J Gu
- Center for Disease Control and Prevention of Changshu and Suzhou City, Suzhou 215500, China
| | - M Wu
- Department of Non-communicable Chronic Disease Control, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China
| | - J Y Zhou
- Department of Non-communicable Chronic Disease Control, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China
| | - C Shen
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| |
Collapse
|
39
|
Jhun CS, Xu L, Siedlecki C, Bartoli CR, Yeager E, Lukic B, Scheib CM, Newswanger R, Cysyk JP, Shen C, Bohnenberger K, Weiss WJ, Rosenberg G. Kinetic and Dynamic Effects on Degradation of von Willebrand Factor. ASAIO J 2023; 69:467-474. [PMID: 36399789 PMCID: PMC10143388 DOI: 10.1097/mat.0000000000001848] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The loss of high molecular weight multimers (HMWM) of von Willebrand factor (vWF) in aortic stenosis (AS) and continuous-flow left ventricular assist devices (cf-LVADs) is believed to be associated with high turbulent blood shear. The objective of this study is to understand the degradation mechanism of HMWM in terms of exposure time (kinetic) and flow regime (dynamics) within clinically relevant pathophysiologic conditions. A custom high-shear rotary device capable of creating fully controlled exposure times and flows was used. The system was set so that human platelet-poor plasma flowed through at 1.75 ml/sec, 0.76 ml/sec, or 0.38 ml/sec resulting in the exposure time ( texp ) of 22, 50, or 100 ms, respectively. The flow was characterized by the Reynolds number (Re). The device was run under laminar (Re = 1,500), transitional (Re = 3,000; Re = 3,500), and turbulent (Re = 4,500) conditions at a given texp followed by multimer analysis. No degradation was observed at laminar flow at all given texp . Degradation of HMWM at a given texp increases with the Re. Re ( p < 0.0001) and texp ( p = 0.0034) are significant factors in the degradation of HMWM. Interaction between Re and texp , however, is not always significant ( p = 0.73).
Collapse
Affiliation(s)
- Choon-Sik Jhun
- From the Division of Applied Biomedical Engineering, Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania
| | - Lichong Xu
- From the Division of Applied Biomedical Engineering, Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania
| | - Christopher Siedlecki
- From the Division of Applied Biomedical Engineering, Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania
- Department of Biomedical Engineering, College of Engineering, The Pennsylvania State University, University Park, Pennsylvania
| | - Carlo R. Bartoli
- Department of Cardiothoracic Surgery, Geisinger Medical Center, Danville, Pennsylvania
| | - Eric Yeager
- From the Division of Applied Biomedical Engineering, Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania
| | - Branka Lukic
- From the Division of Applied Biomedical Engineering, Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania
| | - Christopher M. Scheib
- From the Division of Applied Biomedical Engineering, Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania
| | - Raymond Newswanger
- From the Division of Applied Biomedical Engineering, Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania
| | - Joshua P. Cysyk
- From the Division of Applied Biomedical Engineering, Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania
| | - Chan Shen
- Division of Outcomes Research and Quality, Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania
| | - Karl Bohnenberger
- From the Division of Applied Biomedical Engineering, Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania
| | - William J. Weiss
- From the Division of Applied Biomedical Engineering, Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania
- Department of Biomedical Engineering, College of Engineering, The Pennsylvania State University, University Park, Pennsylvania
| | - Gerson Rosenberg
- From the Division of Applied Biomedical Engineering, Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania
- Department of Biomedical Engineering, College of Engineering, The Pennsylvania State University, University Park, Pennsylvania
| |
Collapse
|
40
|
Perez Holguin RA, DeAngelo N, Sinha A, Shen C, Tsai AY. Cost and outcomes of intercostal nerve cryoablation versus thoracic epidural following the Nuss procedure. J Pediatr Surg 2023; 58:608-612. [PMID: 36646539 DOI: 10.1016/j.jpedsurg.2022.12.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Pectus excavatum is the most common congenital chest wall abnormality, with the Nuss procedure being the most commonly performed repair. Pain control is the predominant factor in the postoperative treatment of these patients. This study aims to compare the cost and outcomes of intercostal nerve cryoablation (INC) and thoracic epidural (TE) in patients undergoing the Nuss procedure. METHODS A retrospective chart review was conducted at our institution for all patients who underwent the Nuss procedure for pectus excavatum from 2002 to 2020. Patients were stratified by pain management strategy, INC vs. TE. Chi-square and Fisher's exact were used to compare categorical variables. Wilcoxon tests were used to evaluate continuous variables and costs. RESULTS A total of 158 patients were identified. Of these, 80.4% (N = 127) were treated with epidural, while 19.6% (N = 31) were treated with intercostal nerve cryoablation. The INC group had lower rates of PCA use (35.5% vs. 93.7%, p < 0.001), lower total morphine milligram equivalent requirement (27.0 vs. 290.8, p < 0.001), and shorter length of stay (3.2 days vs. 5.3 days, p < 0.001) compared to the TE group. INC was also associated with longer operative times (153.0 min vs. 89.0 min, p < 0.001). The total hospitalization cost for the INC group was higher compared to the TE group ($24,742.5 vs $21,621.9, p = 0.001). CONCLUSIONS In patients undergoing the Nuss procedure, compared to thoracic epidural, INC was associated with lower opioid use and shorter length of stay but at the cost of longer operative time and increased hospitalization cost. LEVEL OF EVIDENCE Treatment Study, Level III.
Collapse
Affiliation(s)
- Rolfy A Perez Holguin
- Division of Outcomes Research and Quality, Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, PA USA
| | - Noah DeAngelo
- Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, NC USA
| | | | - Chan Shen
- Division of Outcomes Research and Quality, Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, PA USA
| | - Anthony Y Tsai
- Division of Pediatric Surgery, Penn State Health Children's Hospital, Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, PA USA.
| |
Collapse
|
41
|
Greene AC, Wong WG, Pameijer CR, Shen C. ASO Author Reflections: Lower Guideline Concordance and Decreased Overall Survival for Melanoma Patients at Minority-Serving Hospitals: How Can We Do Better? Ann Surg Oncol 2023; 30:3646-3647. [PMID: 36997820 DOI: 10.1245/s10434-023-13377-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 03/07/2023] [Indexed: 04/01/2023]
Affiliation(s)
- Alicia C Greene
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, USA
| | - William G Wong
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, USA
| | - Colette R Pameijer
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, USA
| | - Chan Shen
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, USA.
| |
Collapse
|
42
|
Greene AC, Wong WG, Perez Holguin RA, Patel A, Pameijer CR, Shen C. The Association of Guideline-Concordant Sentinel Lymph Node Biopsy for Melanoma at Minority-Serving Hospitals. Ann Surg Oncol 2023; 30:3634-3645. [PMID: 36935433 DOI: 10.1245/s10434-023-13341-6] [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] [Received: 01/04/2023] [Accepted: 02/19/2023] [Indexed: 03/21/2023]
Abstract
BACKGROUND Minority-serving hospitals (MSHs) have been associated with lower guideline adherence and worse outcomes for various cancers. However, the relationship among MSH status, concordance with sentinel lymph node biopsy (SLNB) guidelines, and overall survival (OS) for patients with cutaneous melanoma is not well studied. METHODS The National Cancer Database was queried for patients diagnosed with T1a*, T2, and T3 melanoma between 2012 and 2017. MSHs were defined as the top decile of institutions ranked by the proportion of minorities treated for melanoma. Based on National Comprehensive Cancer Network guidelines, guideline-concordant care (GCC) was defined as not undergoing SLNB if thickness was < 0.76 mm without ulceration, mitosis ≥ 1/mm2, or lymphovascular invasion (T1a*), and performing SLNB for patients with intermediate thickness melanomas between 1.0 and 4.0 mm (T2/T3). Multivariable logistic regressions examined associations with GCC. The Kaplan-Meier method and log-rank tests were used to evaluate OS between MSH and non-MSH facilities. RESULTS Overall, 5.9% (N = 2182/36,934) of the overall cohort and 37.8% of minorities (n = 199/527) were managed at MSHs. GCC rates were 89.5% (n = 33,065/36,934) in the overall cohort and 85.4% (n = 450/527) in the minority subgroup. Patients in the overall cohort (odds ratio [OR] 0.85; p = 0.02) and the minority subgroup (OR 0.55; p = 0.02) were less likely to obtain GCC if they received their care at MSHs compared with non-MSHs. Minority patients receiving care at MSHs had a decreased survival compared with those treated at non-MSHs (p = 0.002). CONCLUSIONS Adherence to SLNB guidelines for melanoma was lower at MSHs. Continued focus is needed on equity in melanoma care for minority patients in the United States.
Collapse
Affiliation(s)
- Alicia C Greene
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, USA
| | - William G Wong
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, USA
| | - Rolfy A Perez Holguin
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, USA
| | - Akshilkumar Patel
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, USA
| | - Colette R Pameijer
- Division of Surgical Oncology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Chan Shen
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, USA. .,Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, Hershey, PA, USA.
| |
Collapse
|
43
|
Benavides-Vasquez J, Shen C, McDonald A, Wang L. Effect of residence in nonmetropolitan counties on stage and tumor size at diagnosis in patients with breast cancer: A Surveillance, Epidemiology, and End Results analysis. J Rural Health 2023; 39:408-415. [PMID: 36396348 DOI: 10.1111/jrh.12727] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of this study was to assess the influence of residence in nonmetropolitan versus metropolitan counties on stage and tumor size at diagnosis in patients with breast cancer in the United States. METHODS Women with a primary diagnosis of breast cancer between 2010 and 2015 were selected from the Surveillance, Epidemiology, and End Results (SEER) database. Logistic regression was used to model the effect of residence in nonmetropolitan counties on cancer stage and tumor size, adjusted for age, marital status, and 2 county-level socioeconomic variables. RESULTS The final sample included 267,691 patients. More patients were diagnosed at advanced stages (III-IV vs I-II: 51.11% vs 50.21%) and with larger tumors (>2 cm vs < = 2 cm: 47.62% vs 46.77%) in nonmetropolitan counties. After adjustment, residence in nonmetro counties was not associated with advanced stage at diagnosis (OR = 0.987; 95% CI: 0.959-1.015) or tumor size >2 cm at diagnosis (OR = 0.997; 95% CI: 0.969-1.026). In stratified analysis by race/ethnicity, however, non-Hispanic White patients in nonmetropolitan counties were significantly more likely to have an advanced stage (OR = 1.035, 95% CI: 1.003-1.068) and tumor sizes >2 cm (OR = 1.051; 95% CI: 1.018-1.084) at diagnosis. CONCLUSIONS Residence in nonmetropolitan counties in the United States was not associated with advanced stage or tumor size >2 cm at diagnosis in cases of breast cancer, compared to the residence in metropolitan counties. However, among non-Hispanic White females, residence in nonmetropolitan counties was associated with significantly higher odds of having an advanced stage and a tumor size >2 cm at diagnosis.
Collapse
Affiliation(s)
| | - Chan Shen
- Department of Surgery, Penn State College of Medicine, Hershey, Pennsylvania, USA
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Alicia McDonald
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
- Penn State Cancer Institute, Hershey, Pennsylvania, USA
| | - Li Wang
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
| |
Collapse
|
44
|
Perez Holguin RA, Olecki EJ, Wong WG, Stahl KA, Go PH, Taylor MD, Reed MF, Shen C. Outcomes after sublobar resection versus lobectomy in non-small cell carcinoma in situ. J Thorac Cardiovasc Surg 2023; 165:853-861.e3. [PMID: 35760619 DOI: 10.1016/j.jtcvs.2022.05.032] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 04/13/2022] [Accepted: 05/07/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Guidelines for treatment of non-small cell lung cancer identify patients with tumors ≤2 cm and pure carcinoma in situ histology as candidates for sublobar resection. Although the merits of lobectomy, sublobar resection, and lymphoid (LN) sampling, have been investigated in early-stage non-small cell lung cancer, evaluation of these modalities in patients with IS disease can provide meaningful clinical information. This study aims to compare these operations and their relationship with regional LN sampling in this population. METHODS The National Cancer Database was used to identify patients diagnosed with non-small cell lung cancer clinical Tis N0 M0 with a tumor size ≤2 cm from 2004 to 2017. The χ2 tests were used to examine subgroup differences by type of surgery. Kaplan-Meier method and Cox proportional hazard model were used to compare overall survival. RESULTS Of 707 patients, 56.7% (401 out of 707) underwent sublobar resection and 43.3% (306 out of 707) underwent lobectomy. There was no difference in 5-year overall survival in the sublobar resection group (85.1%) compared with the lobectomy group (88.9%; P = .341). Multivariable survival analyses showed no difference in overall survival (hazard ratio, 1.044; P = .885) in the treatment groups. LN sampling was performed in 50.9% of patients treated with sublobar resection. In this group, LN sampling was not associated with improved survival (84.9% vs 85.0%; P = .741). CONCLUSIONS We observed no difference in overall survival between sublobar resection and lobectomy in patients with cTis N0 M0 non-small cell lung cancer with tumors ≤2 cm. Sublobar resection may be an appropriate surgical option for this population. LN sampling was not associated with improved survival in patients treated with sublobar resection.
Collapse
Affiliation(s)
- Rolfy A Perez Holguin
- Division of Outcomes Research Quality, Department of Surgery, The Pennsylvania State University College of Medicine, Hershey, Pa
| | - Elizabeth J Olecki
- Division of Outcomes Research Quality, Department of Surgery, The Pennsylvania State University College of Medicine, Hershey, Pa
| | - William G Wong
- Division of Outcomes Research Quality, Department of Surgery, The Pennsylvania State University College of Medicine, Hershey, Pa
| | - Kelly A Stahl
- Division of Outcomes Research Quality, Department of Surgery, The Pennsylvania State University College of Medicine, Hershey, Pa
| | - Pauline H Go
- Division of Thoracic Surgery, Department of Surgery, The Pennsylvania State University College of Medicine, Hershey, Pa; Penn State Cancer Institute, Hershey, Pa
| | - Matthew D Taylor
- Division of Thoracic Surgery, Department of Surgery, The Pennsylvania State University College of Medicine, Hershey, Pa; Penn State Cancer Institute, Hershey, Pa
| | - Michael F Reed
- Division of Thoracic Surgery, Department of Surgery, The Pennsylvania State University College of Medicine, Hershey, Pa; Penn State Cancer Institute, Hershey, Pa
| | - Chan Shen
- Division of Outcomes Research Quality, Department of Surgery, The Pennsylvania State University College of Medicine, Hershey, Pa; Penn State Cancer Institute, Hershey, Pa; Division of Health Services and Behavioral Research, Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, Pa.
| |
Collapse
|
45
|
Wong WG, Dasari A, Shen C. Association of Surgery and Chemotherapy in Stage IV Gastroenteropancreatic Neuroendocrine Carcinoma. J Surg Res 2023; 283:407-415. [PMID: 36434836 DOI: 10.1016/j.jss.2022.10.058] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 08/19/2022] [Accepted: 10/16/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The survival benefit of chemotherapy for patients with metastatic gastroenteropancreatic neuroendocrine carcinomas (GEP-NECs) is well established. However, reasons for underutilization of chemotherapy are unknown. METHODS The National Cancer Database (NCDB) was queried for metastatic GEP-NECs from 2009 to 2016. The cohort was stratified by patients who had received chemotherapy and who did not receive chemotherapy. Demographic, socioeconomic, clinical, and treatment characteristics were captured. Multivariable logistic regression examined factors associated with chemotherapy utilization. RESULTS Of the 2367 stage IV GEP-NECs patients identified, 1647 (69.6%) received chemotherapy. Patients with primary site at colon and small bowel, age ≥75, no insurance, and ≥2 comorbidities were less likely to receive chemotherapy than patients with other primary sites, age <75, private insurance, and no comorbidities (P < 0.005). The small bowel and colon were the primary sites with the greatest percentage of patients who received surgery (46.4% and 41.8%, respectively). In these subgroup of patients, surgical intervention was also associated with lower probability of receiving chemotherapy (odds ratio = 0.60, P < 0.005). CONCLUSIONS About 30% of patients with metastatic GEP-NECs did not receive chemotherapy. Primary site location and receipt of surgery were significantly associated with receipt of chemotherapy, with NECs in small bowel and colon being more likely to receive surgery and less likely to receive chemotherapy. While surgery may be considered on an individual basis, increasing efforts to ensure patients with colon or small bowel NECs receive guideline-concordant chemotherapy will positively impact survival. In addition, interventions to improve health insurance coverage to increase receipt of chemotherapy are warranted.
Collapse
Affiliation(s)
- William G Wong
- Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania
| | - Arvind Dasari
- Division of Cancer Medicine, Department of Gastrointestinal (GI) Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Chan Shen
- Division of Outcomes Research and Quality, Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania; Division of Health Services and Behavioral Research, Department of Public Health Sciences, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania.
| |
Collapse
|
46
|
Findley PA, Wiener RC, Mitra S, Wang H, Shen C, Sambamoorthi U. Whole Health in Parts: Omissions from National Data Sets. Popul Health Manag 2023; 26:22-28. [PMID: 36799933 PMCID: PMC10081708 DOI: 10.1089/pop.2022.0197] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
Background: The Whole Health model is a holistic approach to facilitate whole health practices by addressing (1) the physical, mental, and social health of individuals and (2) associated support systems. Several national organizations such as the Institute for Healthcare Improvement's (IHI) Age-Friendly Health Systems (AFHS) movement and, the U.S. Department of Veterans Affairs have implemented whole health frameworks with many common elements and promoted whole health practice and skills. However, implementing a Whole Health model across communities and health systems will require evidence of effectiveness. Generating evidence on the effectiveness of the Whole Health model's effect on health outcomes requires data-driven intelligence. Methods: We identified the national public-use data sets that are most often used in health research with a machine-assisted literature search of PubMed and Scopus for peer-reviewed journal articles published from 2010 through the end of 2021, including preprints, using Python [3.7]. We then assessed if the 8 most commonly used datasets include variables associated with whole health. Results: The number of publications examining whole health has increased annually in the last decade, with more than 2800 publications in 2020 alone. Since 2010, 24,811 articles have been published using 1 of these data sets. However, we also found a lack of data (ie, data set includes all of the whole health variables) to examine whole health in national data sets. Conclusions: We support a call to expand data collection and standardization of critical measures of whole health.
Collapse
Affiliation(s)
| | - R. Constance Wiener
- Department of Dental Public Health and Professional Practice, West Virginia University, Morgantown, West Virginia, USA
| | - Sophie Mitra
- Department of Economics, Research Consortium on Disability, Fordham University, Bronx, New York, USA
| | - Hao Wang
- Department of Emergency Medicine, JPS Health Network, Integrative Emergency Services, Fort Worth, Texas, USA
| | - Chan Shen
- Department of Surgery, Penn State Cancer Institute, Hershey, Pennsylvania, USA
| | - Usha Sambamoorthi
- Department of Pharmacotherapy, College of Pharmacy, “Vashisht” Professor for Health Disparities, HEARD Scholar, Texas Center for Health Disparities, University of North Texas Health Science Center, Fort Worth, Texas, USA
| |
Collapse
|
47
|
Zhou S, Shen C. Efficacy and safety associated with immune checkpoint inhibitors in unresectable hepatocellular carcinoma: A re-analysis of a meta-analysis. JGH Open 2023; 7:163-164. [PMID: 36852153 PMCID: PMC9958338 DOI: 10.1002/jgh3.12856] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 12/12/2022] [Indexed: 01/25/2023]
Abstract
We identified analytic limitations in a recent meta-analysis and re-examined the efficacy and safety associated with immune checkpoint inhibitors (ICIs) in unresectable hepatocellular carcinoma (HCC) compared with standard therapies. Our findings mostly contradict conclusions from the previous study, suggesting the need for continuing the investigation of ICIs in HCC with additional clinical evidence.
Collapse
Affiliation(s)
- Shouhao Zhou
- Department of Public Health Sciences, College of MedicinePennsylvania State UniversityHersheyPennsylvaniaUSA,Penn State Cancer InstitutePennsylvania State UniversityHersheyPennsylvaniaUSA
| | - Chan Shen
- Department of Public Health Sciences, College of MedicinePennsylvania State UniversityHersheyPennsylvaniaUSA,Penn State Cancer InstitutePennsylvania State UniversityHersheyPennsylvaniaUSA,Department of Surgery, College of MedicinePennsylvania State UniversityHersheyPennsylvaniaUSA
| |
Collapse
|
48
|
Wang H, Shen C, Barbaro M, Ho AF, Pathak M, Dunn C, Sambamoorthi U. A Multi-Level Analysis of Individual and Neighborhood Factors Associated with Patient Portal Use among Adult Emergency Department Patients with Multimorbidity. Int J Environ Res Public Health 2023; 20:1231. [PMID: 36673986 PMCID: PMC9859180 DOI: 10.3390/ijerph20021231] [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] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 01/03/2023] [Accepted: 01/06/2023] [Indexed: 06/17/2023]
Abstract
Background: Patient portals tethered to electronic health records (EHR) have become vital to patient engagement and better disease management, specifically among adults with multimorbidity. We determined individual and neighborhood factors associated with patient portal use (MyChart) among adult patients with multimorbidity seen in an Emergency Department (ED). Methods: This study adopted a cross-sectional study design and used a linked database of EHR from a single ED site to patients’ neighborhood characteristics (i.e., zip code level) from the American Community Survey. The study population included all adults (age > 18 years), with at least one visit to an ED and multimorbidity between 1 January 2019 to 31 December 2020 (N = 40,544). Patient and neighborhood characteristics were compared among patients with and without MyChart use. Random-intercept multi-level logistic regressions were used to analyze the associations of patient and neighborhood factors with MyChart use. Results: Only 19% (N = 7757) of adults with multimorbidity used the patient portal. In the fully adjusted multi-level model, at the patient level, having a primary care physician (AOR = 5.55, 95% CI 5.07−6.07, p < 0.001) and health insurance coverage (AOR = 2.41, 95% CI 2.23−2.61, p < 0.001) were associated with MyChart use. At the neighborhood level, 4.73% of the variation in MyChart use was due to differences in neighborhood factors. However, significant heterogeneity existed in patient portal use when neighborhood characteristics were included in the model. Conclusions: Among ED patients with multimorbidity, one in five adults used patient portals. Patient-level factors, such as having primary care physicians and insurance, may promote patient portal use.
Collapse
Affiliation(s)
- Hao Wang
- Department of Emergency Medicine, JPS Health Network, Integrative Emergency Services, 1500 S. Main St., Fort Worth, TX 76104, USA
| | - Chan Shen
- Department of Surgery, Penn State Cancer Institute, Hershey, PA 17033, USA
| | - Michael Barbaro
- Department of Emergency Medicine, JPS Health Network, Integrative Emergency Services, 1500 S. Main St., Fort Worth, TX 76104, USA
| | - Amy F. Ho
- Department of Emergency Medicine, JPS Health Network, Integrative Emergency Services, 1500 S. Main St., Fort Worth, TX 76104, USA
| | - Mona Pathak
- Department of Pharmacotherapy, University of North Texas Health Science Center, Fort Worth, TX 76107, USA
| | - Cita Dunn
- TCU and UNTHSC School of Medicine, 3500 Camp Bowie Blvd, Fort Worth, TX 76107, USA
| | - Usha Sambamoorthi
- Texas Center for Health Disparities, Department of Pharmacotherapy, College of Pharmacy, University of North Texas Health Science Center, Fort Worth, TX 76107, USA
| |
Collapse
|
49
|
Wiener RC, Findley PA, Shen C, Wang H, Mitra S, Sambamoorthi U. Cost Conversation Research. J Am Dent Assoc 2023; 154:6-7. [PMID: 36428127 DOI: 10.1016/j.adaj.2022.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 10/24/2022] [Indexed: 11/23/2022]
Affiliation(s)
- R Constance Wiener
- Associate Professor and Chair, Department of Dental Public Health and Professional Practice, School of Dentistry, West Virginia University, Morgantown, WV
| | - Patricia A Findley
- Professor, MSW Director, Special Assistant to the Dean for Interprofessional Health Initiatives, Rutgers School of Social Work, New Brunswick, NJ
| | - Chan Shen
- Associate Professor, Department of Health Services Research, Penn State College of Medicine, Hershey, PA
| | - Hao Wang
- Department of Emergency Medicine, JPS Health Network, Integrative Emergency Services, Fort Worth, TX
| | - Sophie Mitra
- Department of Economics, Fordham University, Bronx, NY
| | - Usha Sambamoorthi
- Professor, Department of Pharmacotherapy, College of Pharmacy, Texas Center for Health Disparities, University of North Texas Health Science Center, Fort Worth, TX
| |
Collapse
|
50
|
Shaikh NF, Shen C, LeMasters T, Dwibedi N, Ladani A, Sambamoorthi U. Prescription Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) and Incidence of Depression Among Older Cancer Survivors With Osteoarthritis: A Machine Learning Analysis. Cancer Inform 2023; 22:11769351231165161. [PMID: 37101728 PMCID: PMC10123903 DOI: 10.1177/11769351231165161] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 03/05/2023] [Indexed: 04/28/2023] Open
Abstract
ObjectiveS This study examined prescription NSAIDs as one of the leading predictors of incident depression and assessed the direction of the association among older cancer survivors with osteoarthritis. Methods This study used a retrospective cohort (N = 14, 992) of older adults with incident cancer (breast, prostate, colorectal cancers, or non-Hodgkin's lymphoma) and osteoarthritis. We used the longitudinal data from the linked Surveillance, Epidemiology, and End Results -Medicare data for the study period from 2006 through 2016, with a 12-month baseline and 12-month follow-up period. Cumulative NSAIDs days was assessed during the baseline period and incident depression was assessed during the follow-up period. An eXtreme Gradient Boosting (XGBoost) model was built with 10-fold repeated stratified cross-validation and hyperparameter tuning using the training dataset. The final model selected from the training data demonstrated high performance (Accuracy: 0.82, Recall: 0.75, Precision: 0.75) when applied to the test data. SHapley Additive exPlanations (SHAP) was used to interpret the output from the XGBoost model. Results Over 50% of the study cohort had at least one prescption of NSAIDs. Nearly 13% of the cohort were diagnosed with incident depression, with the rates ranging between 7.4% for prostate cancer and 17.0% for colorectal cancer. The highest incident depression rate of 25% was observed at 90 and 120 cumulative NSAIDs days thresholds. Cumulative NSAIDs days was the sixth leading predictor of incident depression among older adults with OA and cancer. Age, education, care fragmentation, polypharmacy, and zip code level poverty were the top 5 predictors of incident depression. Conclusion Overall, 1 in 8 older adults with cancer and OA were diagnosed with incident depression. Cumulative NSAIDs days was the sixth leading predictor with an overall positive association with incident depression. However, the association was complex and varied by the cumulative NSAIDs days.
Collapse
Affiliation(s)
- Nazneen Fatima Shaikh
- Department of Pharmaceutical Systems and Policy, West Virginia University School of Pharmacy, Morgantown, WV, USA
| | - Chan Shen
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, USA
- Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, Hershey, PA, USA
- Chan Shen, Department of Surgery, College of Medicine, The Pennsylvania State University, 700 HMC Crescent Road, Hershey, PA 17033-2360, USA.
| | - Traci LeMasters
- Department of Pharmaceutical Systems and Policy, West Virginia University School of Pharmacy, Morgantown, WV, USA
| | | | - Amit Ladani
- Department of Medicine, Section of Rheumatology, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Usha Sambamoorthi
- Pharmacotherapy Department College of Pharmacy, “Vashisht” Professor of Health Disparities, HEARD Scholar, Institute for Health Disparities, University of North Texas Health Sciences Center, Fort Worth, TX, USA
| |
Collapse
|