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Freudenberger DC, Riner AN, Herremans KM, Vudatha V, McGuire KP, Anand RJ, Trevino JG. A Gravid Situation: General Surgery Faculty Support for Pregnant Surgical Residents. J Surg Res 2024; 299:9-16. [PMID: 38677003 DOI: 10.1016/j.jss.2024.03.002] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 01/05/2024] [Accepted: 03/11/2024] [Indexed: 04/29/2024]
Abstract
INTRODUCTION The perceptions of teaching faculty toward pregnant general surgery residents have been overlooked despite the daily interactions amongst these groups. METHODS A 32-question survey designed to measure general surgery teaching faculty perceptions toward pregnant residents was distributed electronically from March 2022 to April 2022 to general surgery teaching faculty in the United States. Descriptive statistics were used to characterize responses and differences in perceptions, and qualitative analysis identified recurring themes from free-text responses. RESULTS Among 163 respondents included in the final analysis, 58.5% were male and 41.5% were female. Despite 99.4% of surgeons feeling comfortable if a resident told them they were pregnant, 22.4% of surgeons disagreed that their institutions have supportive cultures toward pregnancy. Almost half (45.4%) have witnessed negative comments about pregnant residents and half (50.3%) believe that pregnant surgical residents are discriminated against by their coresidents. Nearly two-thirds of surgeons (64.8%) believe that someone should have a child whenever they wish during training. Given recent reports, 80.2% of surgeons recognized that female surgeons have increased risks of infertility and pregnancy complications. Recurring themes of normalizing pregnancy, improving policies, and creating a culture change were expressed. CONCLUSIONS In this national survey, although there appears to be positive perceptions of pregnancy in surgical training amongst those surveyed, there is acknowledged necessity of further normalizing pregnancy and improving policies to better support pregnant residents. These data provide further evidence that though perceptions may be improving, changes are still needed to better support pregnancy during training.
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Affiliation(s)
- Devon C Freudenberger
- Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Andrea N Riner
- Department of Surgery, University of Florida College of Medicine, Gainesville, Florida
| | - Kelly M Herremans
- Department of Surgery, University of Florida College of Medicine, Gainesville, Florida
| | - Vignesh Vudatha
- Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Kandace P McGuire
- Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Rahul J Anand
- Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Jose G Trevino
- Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia.
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Alwatari Y, Freudenberger DC, Khoraki J, Bless L, Payne R, Julliard WA, Shah RD, Puig CA. Emergent Esophagectomy in Patients with Esophageal Malignancy Is Associated with Higher Rates of Perioperative Complications but No Independent Impact on Short-Term Mortality. J Chest Surg 2024; 57:160-168. [PMID: 38321624 DOI: 10.5090/jcs.23.149] [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: 10/25/2023] [Revised: 12/04/2023] [Accepted: 12/07/2023] [Indexed: 02/08/2024] Open
Abstract
Background Data on perioperative outcomes of emergent versus elective resection in esophageal cancer patients requiring esophagectomy are lacking. We investigated whether emergent resection was associated with increased risks of morbidity and mortality. Methods Data on patients with esophageal malignancy who underwent esophagectomy from 2005 to 2020 were retrospectively analyzed from the American College of Surgeons National Surgical Quality Improvement Program database. Thirty-day complication and mortality rates were compared between emergent esophagectomy (EE) and non-emergent esophagectomy. Logistic regression assessed factors associated with complications and mortality. Results Of 10,067 patients with malignancy who underwent esophagectomy, 181 (1.8%) had EE, 64% had preoperative systemic inflammatory response syndrome, sepsis, or septic shock, and 44% had bleeding requiring transfusion. The EE group had higher American Society of Anesthesiologists (ASA) class and functional dependency. More transhiatal esophagectomies and diversions were performed in the EE group. After EE, the rates of 30-day mortality (6.1% vs. 2.8%), overall complications (65.2% vs. 44.2%), bleeding, pneumonia, prolonged intubation, and positive margin (17.7% vs. 7.4%) were higher, while that of anastomotic leak was similar. On adjusted logistic regression, older age, lower albumin, higher ASA class, and fragility were associated with increased complications and mortality. McKeown esophagectomy and esophageal diversion were associated with a higher risk of postoperative complications. EE was associated with 30-day postoperative complications (odds ratio, 2.39; 95% confidence interval, 1.66-3.43; p<0.0001). Conclusion EE was associated with a more than 2-fold increase in complications compared to elective procedures, but no independent increase in short-term mortality. These findings may help guide data-driven critical decision-making for surgery in select cases of complicated esophageal malignancy.
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Affiliation(s)
- Yahya Alwatari
- Section of Thoracic & Foregut Surgery, Department of Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - Devon C Freudenberger
- Section of Thoracic & Foregut Surgery, Department of Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - Jad Khoraki
- Section of Thoracic & Foregut Surgery, Department of Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - Lena Bless
- Section of Thoracic & Foregut Surgery, Department of Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - Riley Payne
- Section of Thoracic & Foregut Surgery, Department of Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - Walker A Julliard
- Section of Thoracic & Foregut Surgery, Department of Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - Rachit D Shah
- Section of Thoracic & Foregut Surgery, Department of Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - Carlos A Puig
- Section of Thoracic & Foregut Surgery, Department of Surgery, Virginia Commonwealth University, Richmond, VA, USA
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Riner AN, Herremans KM, Vudatha V, Han S, Qu X, Liu J, Mukhopadhyay N, Freudenberger DC, George TJ, Judge SM, Judge AR, Hughes SJ, Trevino JG. Heterogeneity of weight loss and transcriptomic signatures in pancreatic ductal adenocarcinoma. J Cachexia Sarcopenia Muscle 2024; 15:149-158. [PMID: 38123146 PMCID: PMC10834348 DOI: 10.1002/jcsm.13390] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 09/27/2023] [Accepted: 11/02/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Pancreatic ductal adenocarcinoma (PDAC) is highly associated with cachexia and weight loss, which is driven by the tumour's effect on the body. Data are lacking on differences in these metrics based on PDAC anatomic location. We hypothesize that the primary tumour's anatomic region influences the prevalence and severity of unintentional weight loss. METHODS Treatment naïve patients with PDAC who underwent pancreatectomy at a single institution between 2012 and 2020 were identified retrospectively. Patients with pancreatic head or distal tumours were matched by sex, age, N and T stage. Serologic and anthropometric variables were obtained at the time of diagnosis. Skeletal muscle index (SMI), muscle radiation attenuation (MRA) and adiposity were measured. The primary outcome was presence of significant weight loss [>5% body weight (BW) loss in past 6 months]. Signed rank tests, Cochran Mantel Haenszel tests and Kaplan-Meier survival analysis are presented. RNA-seq of tumours was performed to explore enriched pathways related to cachexia and weight loss. RESULTS Pancreatic head tumours (n = 24) were associated with higher prevalence (70.8% vs. 41.7%, P = 0.081) and degree of weight loss (7.9% vs. 2.5%, P = 0.014) compared to distal tumours (n = 24). BMI (P = 0.642), SMI (P = 0.738) and MRA (P = 0.478) were similar between groups. Combining BW loss, SMI and MRA into a composite score, patients with pancreatic head cancers met more criteria associated with poor prognosis (P = 0.142). Serum albumin (3.9 vs. 4.4 g/dL, P = 0.002) was lower and bilirubin (4.5 vs. 0.4 mg/dL, P < 0.001) were higher with pancreatic head tumours. Survival differed by tumour location (P = 0.014) with numerically higher median overall survival with distal tumours (11.1 vs. 21.8 months; P = 0.066). Transcriptomic analysis revealed inactivation of appetite stimulation, weight regulation and nutrient digestion/metabolism pathways in pancreatic head tumours. CONCLUSIONS Resectable pancreatic head PDAC is associated with higher prevalence of significant weight loss and more poor prognosis features. Pancreaticobiliary obstruction and hypoalbuminemia in patients with head tumours suggests compounding effects of nutrient malabsorption and systemic inflammation on molecular drivers of cachexia, possibly contributing to shorter survival. Therefore, PDAC-associated cachexia is a heterogenous syndrome, which may be influenced by the primary tumour location. Select patients with resectable pancreatic head tumours may benefit from nutritional rehabilitation to improve outcomes.
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Affiliation(s)
- Andrea N Riner
- Department of Surgery, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Kelly M Herremans
- Department of Surgery, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Vignesh Vudatha
- Department of Surgery, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Song Han
- Department of Surgery, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Xufeng Qu
- Department of Biostatistics, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Jinze Liu
- Department of Biostatistics, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Nitai Mukhopadhyay
- Department of Biostatistics, Virginia Commonwealth University, Richmond, Virginia, USA
| | | | - Thomas J George
- Department of Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Sarah M Judge
- Department of Physical Therapy, University of Florida Health Science Center, Gainesville, Florida, USA
| | - Andrew R Judge
- Department of Physical Therapy, University of Florida Health Science Center, Gainesville, Florida, USA
| | - Steven J Hughes
- Department of Surgery, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Jose G Trevino
- Department of Surgery, Virginia Commonwealth University, Richmond, Virginia, USA
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Freudenberger DC, Herremans KM, Riner AN, Vudatha V, McGuire KP, Anand RJ, Trevino JG. General Surgery Faculty Knowledge and Perceptions of Breast Pumping Amongst Postpartum Surgical Residents. World J Surg 2023; 47:2092-2100. [PMID: 37103559 PMCID: PMC10387458 DOI: 10.1007/s00268-023-07005-5] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2023] [Indexed: 04/28/2023]
Abstract
BACKGROUND There is a lack of data regarding the knowledge and perceptions teaching faculty possess about breast pumping among general surgery residents despite breast pumping becoming more common during training. This study aimed to examine faculty knowledge and perceptions of breast pumping amongst general surgery residents. METHODS A 29-question survey measuring knowledge and perceptions about breast pumping was administered online to United States teaching faculty from March-April 2022. Descriptive statistics were used to characterize responses, Fisher's exact test was used to report differences in responses by surgeon sex and age, and qualitative analysis identified recurrent themes. RESULTS 156 responses were analyzed; 58.6% were male and 41.4% were female, and the majority (63.5%) were less than 50 years old. Nearly all (97.7%) women with children breast pumped, while 75.3% of men with children had partners who pumped. Men more often than women indicated "I don't know" when asked about frequency (24.7 vs. 7.9%, p = 0.041) and duration (25.0 vs. 9.5%, p = 0.007) of pumping. Nearly all surgeons are comfortable (97.4%) discussing lactation needs and support (98.1%) breast pumping, yet only two-thirds feel their institutions are supportive. Almost half (41.0%) of surgeons agreed that breast pumping does not impact operating room workflow. Recurring themes included normalizing breast pumping, creating change to better support residents, and communicating needs between all parties. CONCLUSIONS Teaching faculty may have supportive perceptions about breast pumping, but knowledge gaps may hinder greater levels of support. Opportunities exist for increased faculty education, communication, and policies to better support breast pumping residents.
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Affiliation(s)
- Devon C Freudenberger
- Department of Surgery, Virginia Commonwealth University School of Medicine, 1200 E. Broad St., PO Box 980011, Richmond, VA, 23219, USA
| | - Kelly M Herremans
- Department of Surgery, University of Florida College of Medicine, 1600 SW Archer Rd., Gainesville, FL, 32608, USA
| | - Andrea N Riner
- Department of Surgery, University of Florida College of Medicine, 1600 SW Archer Rd., Gainesville, FL, 32608, USA
| | - Vignesh Vudatha
- Department of Surgery, Virginia Commonwealth University School of Medicine, 1200 E. Broad St., PO Box 980011, Richmond, VA, 23219, USA
| | - Kandace P McGuire
- Department of Surgery, Virginia Commonwealth University School of Medicine, 1200 E. Broad St., PO Box 980011, Richmond, VA, 23219, USA
| | - Rahul J Anand
- Department of Surgery, Virginia Commonwealth University School of Medicine, 1200 E. Broad St., PO Box 980011, Richmond, VA, 23219, USA
| | - Jose G Trevino
- Department of Surgery, Virginia Commonwealth University School of Medicine, 1200 E. Broad St., PO Box 980011, Richmond, VA, 23219, USA.
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Freudenberger DC, Vudatha V, Wolfe LG, Riner AN, Herremans KM, Sparkman BK, Fernandez LJ, Trevino JG. Race and Ethnicity Impacts Overall Survival of Patients with Appendiceal Cancer Who Undergo Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy. Cancers (Basel) 2023; 15:3990. [PMID: 37568806 PMCID: PMC10417044 DOI: 10.3390/cancers15153990] [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: 05/31/2023] [Revised: 07/18/2023] [Accepted: 07/26/2023] [Indexed: 08/13/2023] Open
Abstract
Appendiceal cancer treatment may include cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC). We investigated whether patient race/ethnicity influences outcomes and overall survival for patients with appendiceal cancer who undergo CRS/HIPEC. We queried the National Cancer Database for adult patients with appendiceal cancer treated with CRS/HIPEC from 2006 to 2018. Patients were stratified by race/ethnicity: non-Hispanic White (NHW), non-Hispanic Black (NHB), Hispanic, and Other. Sociodemographics and outcomes were compared using descriptive statistics. Kaplan-Meier survival analysis and Log-rank tests assessed differences in overall survival (OS). Cox Multivariate Regression evaluated factors associated with OS. In total, 2532 patients were identified: 2098 (82.9%) NHW, 186 (7.3%) NHB, 127 (5.0%) Hispanic, and 121 (4.8%) Other patients. The sociodemographics were statistically different across groups. The perioperative and postoperative outcomes were similar. OS was significantly different by race/ethnicity (p = 0.0029). NHB patients compared to Hispanic patients had the shortest median OS (106.7 vs. 145.9 months, p = 0.0093). Race/ethnicity was independently associated with OS: NHB (HR: 2.117 [1.306, 3.431], p = 0.0023) and NHW (HR: 1.549 [1.007, 2.383], p = 0.0463) patients compared to Hispanic patients had worse survival rates. Racial/ethnic disparities exist for patients with appendiceal cancer undergoing CRS/HIPEC. Despite having similar tumor and treatment characteristics, OS is associated with patient race/ethnicity.
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Affiliation(s)
- Devon C. Freudenberger
- Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA 23298, USA; (D.C.F.); (V.V.); (L.G.W.); (B.K.S.); (L.J.F.)
| | - Vignesh Vudatha
- Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA 23298, USA; (D.C.F.); (V.V.); (L.G.W.); (B.K.S.); (L.J.F.)
| | - Luke G. Wolfe
- Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA 23298, USA; (D.C.F.); (V.V.); (L.G.W.); (B.K.S.); (L.J.F.)
| | - Andrea N. Riner
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL 32610, USA; (A.N.R.); (K.M.H.)
| | - Kelly M. Herremans
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL 32610, USA; (A.N.R.); (K.M.H.)
| | - Brian K. Sparkman
- Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA 23298, USA; (D.C.F.); (V.V.); (L.G.W.); (B.K.S.); (L.J.F.)
| | - Leopoldo J. Fernandez
- Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA 23298, USA; (D.C.F.); (V.V.); (L.G.W.); (B.K.S.); (L.J.F.)
| | - Jose G. Trevino
- Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA 23298, USA; (D.C.F.); (V.V.); (L.G.W.); (B.K.S.); (L.J.F.)
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McKinley KNL, Herremans KM, Riner AN, Vudatha V, Freudenberger DC, Hughes SJ, Triplett EW, Trevino JG. Translocation of Oral Microbiota into the Pancreatic Ductal Adenocarcinoma Tumor Microenvironment. Microorganisms 2023; 11:1466. [PMID: 37374966 DOI: 10.3390/microorganisms11061466] [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: 04/11/2023] [Revised: 05/04/2023] [Accepted: 05/22/2023] [Indexed: 06/29/2023] Open
Abstract
Oral dysbiosis has long been associated with pancreatic ductal adenocarcinoma (PDAC). In this work, we explore the relationship between the oral and tumor microbiomes of patients diagnosed with PDAC. Salivary and tumor microbiomes were analyzed using a variety of sequencing methods, resulting in a high prevalence and relative abundance of oral bacteria, particularly Veillonella and Streptococcus, within tumor tissue. The most prevalent and abundant taxon found within both saliva and tumor tissue samples, Veillonella atypica, was cultured from patient saliva, sequenced and annotated, identifying genes that potentially contribute to tumorigenesis. High sequence similarity was observed between sequences recovered from patient matched saliva and tumor tissue, indicating that the taxa found in PDAC tumors may derive from the mouth. These findings may have clinical implications in the care and treatment of patients diagnosed with PDAC.
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Affiliation(s)
- Kelley N L McKinley
- Department of Microbiology and Cell Science, University of Florida, Gainesville, FL 32611, USA
| | - Kelly M Herremans
- Department of Surgery, College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Andrea N Riner
- Department of Surgery, College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Vignesh Vudatha
- Division of Surgical Oncology, Virginia Commonwealth University, Richmond, VA 23298, USA
| | - Devon C Freudenberger
- Division of Surgical Oncology, Virginia Commonwealth University, Richmond, VA 23298, USA
| | - Steven J Hughes
- Department of Surgery, College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Eric W Triplett
- Department of Microbiology and Cell Science, University of Florida, Gainesville, FL 32611, USA
| | - Jose G Trevino
- Division of Surgical Oncology, Virginia Commonwealth University, Richmond, VA 23298, USA
- Massey Cancer Center, Virginia Commonwealth University, Richmond, VA 23298, USA
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Vudatha V, Herremans KM, Freudenberger DC, Liu C, Trevino JG. In vivo models of pancreatic ductal adenocarcinoma. Adv Cancer Res 2023; 159:75-112. [PMID: 37268402 DOI: 10.1016/bs.acr.2023.02.002] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Pancreatic ductal adenocarcinoma (PDAC) is an aggressive malignancy with high mortality rate. Within the next decade, PDAC is projected to become the second leading cause of cancer-associated death in the United States. Understanding the pathophysiology of PDAC tumorigenesis and metastases is crucial toward developing new therapeutics. One of the challenges in cancer research is generating in vivo models that closely recapitulate the genomic, histological, and clinical characteristics of human tumors. An ideal model for PDAC not only captures the tumor and stromal environment of human disease, but also allows for mutational control and is easy to reproduce in terms of time and cost. In this review, we highlight evolution of in vivo models for PDAC including spontaneous tumors models (i.e., chemical induction, genetic modification, viral delivery), implantation models including patient derived xenografts (PDX), and humanized PDX. We discuss the implementation of each system and evaluate the benefits and shortcomings of these models. Overall, this review provides a broad overview of prior and current techniques of in vivo PDAC modeling and their associated challenges.
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Affiliation(s)
- Vignesh Vudatha
- Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA, United States
| | - Kelly M Herremans
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL, United States
| | - Devon C Freudenberger
- Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA, United States
| | - Christopher Liu
- Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA, United States
| | - Jose G Trevino
- Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA, United States; Division of Surgical Oncology, VCU Massey Cancer Center, Virginia Commonwealth University, School of Medicine, Richmond, VA, United States.
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Riner AN, Freudenberger DC, Herremans KM, Vudatha V, Neal DW, George TJ, Trevino JG. Call to action: overcoming enrollment disparities in cancer clinical trials with modernized eligibility criteria. JNCI Cancer Spectr 2023; 7:7049523. [PMID: 36806713 PMCID: PMC9978314 DOI: 10.1093/jncics/pkad009] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/26/2022] [Accepted: 02/03/2023] [Indexed: 02/23/2023] Open
Abstract
Traditional clinical trial eligibility criteria restrict study populations, perpetuating enrollment disparities. We aimed to assess implementation of modernized eligibility criteria guidelines among pancreatic cancer (PC) clinical trials. Interventional PC trials in the United States since January 1, 2014, were identified via clinicaltrials.gov with December 31, 2017, as the transition for pre- and postguidance eras. Trials were assessed for guideline compliance and compared using Fisher exact test. In total, 198 trials were identified: 86 (43.4%) were pre- and 112 (56.6%) postguidance era. Improvements were seen in allowing patients with history of HIV (8.6% vs 43.8%; P < .0001), prior cancer (57.0% vs 72.3%; P = .034), or concurrent and/or stable cancer (2.1% vs 31.1%; P < .0001) to participate. Most (>95%) trials were compliant with laboratory reference ranges, QT interval corrected for heart rate (QTc) cutoffs, and rationalizing excluding prior therapies both pre- and postguidance eras. However, overall compliance with modernized criteria remains poor. We advocate for stakeholders to update protocols and scrutinize traditionally restrictive eligibility criteria.
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Affiliation(s)
- Andrea N Riner
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL, USA
| | - Devon C Freudenberger
- Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Kelly M Herremans
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL, USA
| | - Vignesh Vudatha
- Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Daniel W Neal
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL, USA
| | - Thomas J George
- Department of Medicine, Division of Hematology and Oncology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Jose G Trevino
- Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA, USA.,Massey Cancer Center, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
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Glasgow TE, Miller CA, McGuire KP, Freudenberger DC, Fuemmeler BF. Support for cancer prevention public health policies: results from a nationally representative sample of residents in the United States. Transl Behav Med 2022; 12:1124-1132. [PMID: 35972325 PMCID: PMC9802572 DOI: 10.1093/tbm/ibac056] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 01/21/2023] Open
Abstract
Assessing public support of health policies designed to reduce cancer risk is important for policy implementation. This study aimed to identify support for cancer prevention policies and factors associated with support. Data were obtained from the Health Information National Trends Survey. Support for three types of cancer prevention policies were evaluated: tobacco, alcohol, and junk food regulations. Linear and logistic regression analyses were employed to assess the relationship between support for the different types of policies and sociodemographic, lifestyle behaviors, and cancer beliefs. Certain policies, such as providing warning labels on cigarettes (69.9% support) and requiring specific health warnings on alcohol containers (65.1% support), were popular. Banning outdoor advertising of alcohol was not popular (34.4% support). There were individual differences associated with policy support. For example, respondents who were 75 years or older (B = 0.61, p < .001) or female (B = 0.14, p < .008) were more likely to support tobacco polices compared to their counterparts (i.e., younger or male). Respondents who identified as politically conservative (B = -0.20, p < .004) or those who endorsed high cancer fatalistic beliefs (e.g., there's not much you can do to lower your chances of getting cancer, B = -0.07, p < .012) were less likely to support alcohol policies compared to those who were liberal or had lower cancer fatalistic beliefs. Generally, support was high for most policy questions. However, support varied by different individual factors. The findings also highlight that there may be opportunities to increase understanding and awareness about cancer prevention policies, especially among some segments of the population.
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Affiliation(s)
- Trevin E Glasgow
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Carrie A Miller
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Kandace P McGuire
- Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Devon C Freudenberger
- Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Bernard F Fuemmeler
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
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Herremans KM, Riner AN, Charles AM, Balch JA, Vudatha V, Freudenberger DC, Nassour I, Hughes SJ, Trevino JG, Loftus TJ. From bench to bedside: Pursuing equity in precision medicine approaches to pancreatic cancer care. Front Oncol 2022; 12:1086779. [PMID: 36568255 PMCID: PMC9779942 DOI: 10.3389/fonc.2022.1086779] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 11/29/2022] [Indexed: 12/13/2022] Open
Affiliation(s)
- Kelly M. Herremans
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL, United States
| | - Andrea N. Riner
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL, United States
| | - Angel M. Charles
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL, United States
| | - Jeremy A. Balch
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL, United States
| | - Vignesh Vudatha
- Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA, United States
| | - Devon C. Freudenberger
- Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA, United States
| | - Ibrahim Nassour
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL, United States
| | - Steven J. Hughes
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL, United States
| | - Jose G. Trevino
- Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA, United States
| | - Tyler J. Loftus
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL, United States,*Correspondence: Tyler J. Loftus,
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Riner AN, Girma S, Vudatha V, Mukhopadhyay N, Skoro N, Gal TS, Freudenberger DC, Herremans KM, George TJ, Trevino JG. Eligibility Criteria Perpetuate Disparities in Enrollment and Participation of Black Patients in Pancreatic Cancer Clinical Trials. J Clin Oncol 2022; 40:2193-2202. [PMID: 35316089 PMCID: PMC9273372 DOI: 10.1200/jco.21.02492] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 02/07/2022] [Accepted: 02/18/2022] [Indexed: 12/21/2022] Open
Abstract
PURPOSE Clinical trials determine safety and efficacy of cancer therapeutics and establish standards of care. Minority patient participation in cancer clinical trials is dismal. We aimed to determine the impact of eligibility criteria on disparities in pancreatic ductal adenocarcinoma (PDAC) clinical trial candidacy. METHODS Traditional PDAC trial eligibility criteria were obtained from ClinicalTrials.gov. Patients with PDAC who sought care at Virginia Commonwealth University Health from 2010 to 2019 were included. Clinical data were obtained from billing codes and discrete values in the electronic medical record. Eligibility criteria differences between racial groups were determined using chi-squared tests and unconditional maximum likelihood-based odds ratios. RESULTS Among 676 patients, most identified as Black or White race (42.5% and 51.6%, respectively). Using traditional criteria, Black patients were more likely to be ineligible for participation compared with White patients (42.4% v 33.2%, P = .023) secondary to hypoalbuminemia (14.1% v 7.9%, P = .023), HIV (3.1% v 0.3%, P = .010), hepatitis B (1.7% v 0%, P = .043), and hepatitis C (9.1% v 3.4%, P = .005). Black patients were also numerically more likely to be ineligible because of renal dysfunction, recent coronary stenting, and uncontrolled diabetes mellitus. Prior cancer treatment excluded fewer Black than White patients (9.1% v 14.0%, P = .072), most attributable to lower rates of neoadjuvant chemotherapy received. Strategic eligibility criteria revisions could equalize ineligibility rates between Black and White patients (26.8% v 24.8%, P = .581). CONCLUSION Traditional eligibility criteria differentially exclude Black patients from participating in PDAC clinical trials. These criteria perpetuate disparities, limit generalizability, and are often not medically justifiable. Revised criteria may improve participant diversity, without compromising safety or study results.
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Affiliation(s)
- Andrea N. Riner
- University of Florida College of Medicine, Department of Surgery, Gainesville, FL
| | - Selamawit Girma
- Virginia Commonwealth University, Massey Cancer Center, Richmond, VA
| | - Vignesh Vudatha
- Virginia Commonwealth University, Department of Surgery, Richmond, VA
| | - Nitai Mukhopadhyay
- Virginia Commonwealth University, Department of Biostatistics, Richmond, VA
| | - Nevena Skoro
- Virginia Commonwealth University, Massey Cancer Center, Richmond, VA
| | - Tamas S. Gal
- Virginia Commonwealth University, Massey Cancer Center, Richmond, VA
| | | | - Kelly M. Herremans
- University of Florida College of Medicine, Department of Surgery, Gainesville, FL
| | - Thomas J. George
- University of Florida College of Medicine, Department of Medicine, Division of Hematology and Oncology, Gainesville, FL
| | - Jose G. Trevino
- Virginia Commonwealth University, Massey Cancer Center, Richmond, VA
- Virginia Commonwealth University, Department of Surgery, Richmond, VA
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Freudenberger DC, Deng X, Vudatha V, Riner AN, Herremans KM, Bandyopadhyay D, Fernandez LJ, Trevino JG. Racial Disparities in Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: Does Aggressive Surgical Treatment Overcome Cancer Health Inequities? Front Oncol 2022; 12:899488. [PMID: 35756651 PMCID: PMC9213675 DOI: 10.3389/fonc.2022.899488] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 05/23/2022] [Indexed: 11/13/2022] Open
Abstract
Background Advanced cancer states perpetuate health-related disparities. Peritoneal-based cancers are clinically advanced cancers that present a significant clinical dilemma. Peritoneal cancers are managed aggressively with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). While racial and ethnic disparities are prevalent in cancer, there are no studies investigating if racial disparities exist in patients with peritoneal carcinomatosis managed with CRS and HIPEC. We hypothesized that this advanced disease state further delineates racial disparities. Methods A retrospective chart review was conducted on patients with peritoneal carcinomatosis receiving CRS and HIPEC at a single institution from January 1, 2017-October 4, 2021. Descriptive statistics were used to compare racial groups. The Cox Proportional Hazards Model and Log Rank Test were used for multivariate and overall survival analysis. Results In total, 67 patients underwent CRS and HIPEC, of which 41 (61.2%) were White, 20 (29.8%) were Black, 3 (4.5%) were Asian, and 3 (4.5%) were Other race. When compared to White patients, Black patients had lower income (p=0.0011), higher incidence of hypertension (p=0.0231), and lower performance status (p=0.0441). Cancer type, including colorectal, appendiceal, ovarian, etc., was similar between groups (p=0.8703). Despite these differences in sociodemographic and morbidity factors, when comparing Black patients to White patients, there were no differences in peritoneal cancer index score (13.2 vs. 12.3, p=0.6932), estimated blood loss (748 vs. 655 mL, p=0.6332), minor/major complication rates (1.1 vs. 1.2, p=0.7281; 0.4 vs. 0.7, p=0.3470, respectively), 30-day readmission rates (25.0% vs. 17.1%, p=0.6210), disease recurrence (40.0% vs. 51.2%, p=0.3667), or 30-day mortality (0.0% vs. 2.4%, p=1.0000). Overall survival was similar for Black and White patients (p=0.2693). The occurrence of a major complication was the only factor associated with overall survival (HR 2.188 [1.502, 3.188], p< 0.0001). Conclusions Despite differences in patient socioeconomic factors and comorbid conditions, outcomes were similar between Black and White patients receiving CRS and HIPEC at our institution. While larger studies with more diverse patient populations are needed to confirm these findings, our data provide evidence that aggressive surgical management across diverse patient populations allows for equitable outcomes.
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Affiliation(s)
- Devon C Freudenberger
- Division of Surgical Oncology, Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA, United States
| | - Xiaoyan Deng
- Department of Biostatistics, Virginia Commonwealth University School of Medicine, Richmond, VA, United States
| | - Vignesh Vudatha
- Division of Surgical Oncology, Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA, United States
| | - Andrea N Riner
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL, United States
| | - Kelly M Herremans
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL, United States
| | - Dipankar Bandyopadhyay
- Department of Biostatistics, Virginia Commonwealth University School of Medicine, Richmond, VA, United States
| | - Leopoldo J Fernandez
- Division of Surgical Oncology, Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA, United States
| | - Jose G Trevino
- Division of Surgical Oncology, Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA, United States
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Freudenberger DC, Shah RD. A narrative review of the health disparities associated with malignant pleural mesothelioma. J Thorac Dis 2021; 13:3809-3815. [PMID: 34277071 PMCID: PMC8264689 DOI: 10.21037/jtd-20-3516] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 04/08/2021] [Indexed: 11/08/2022]
Abstract
Malignant pleural mesothelioma (MPM) is a cancer of the mesothelial lining of the pleura that has traditionally been associated with asbestos exposure in an industrial setting. Asbestos usage has fortunately been banned or phased out in most industrialized countries resulting in its decline in countries such as the United States. Despite this, MPM continues to place significant burden on its affected patients resulting in overall poor prognosis and survival. Questions arise as to what factors, especially what health disparities, contribute to the disease’s dismal prognosis. This article will present a narrative review of recent literature that identifies the impact age, sex, race, access to medical centers, and economics have on the diagnosis, treatment, and prognosis of MPM. As will be discussed, research has shown that factors including younger age, female sex, non-white race, private insurance, Medicare, and higher income have been associated with better survival in MPM. Whereas older age, male sex, white race, lack of insurance, and lower income are associated with worse survival. The identification of these and other health disparities related to MPM may allow for future research, clinical guidelines, and policies to be implemented to decrease the burden health disparities create in the diagnosis, treatment, and prognosis of patients with MPM.
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Affiliation(s)
- Devon C Freudenberger
- Division of Cardiothoracic Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Rachit D Shah
- Division of Cardiothoracic Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
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