1
|
Kelly-Quinn M, Biggs JN, Brooks S, Fortuño P, Hegarty S, Jones JI, Regan F. Opportunities, approaches and challenges to the engagement of citizens in filling small water body data gaps. Hydrobiologia 2022; 850:1-21. [PMID: 36065211 PMCID: PMC9430020 DOI: 10.1007/s10750-022-04973-y] [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: 04/24/2022] [Revised: 07/20/2022] [Accepted: 07/22/2022] [Indexed: 06/15/2023]
Abstract
Monitoring the condition (water quality, biodiversity, hydromorphology) of small water bodies presents a challenge for the relevant authorities in terms of time and resources (labour and financial) due to the extensive length of the stream network or the sheer number of small standing water bodies. Citizen science can help address information gaps, but the effort required should not be underestimated if such projects are to generate reliable and sustained data collection. The overall aim of this paper is to propose a framework for operationalisation of citizen science targeting collection of data from small water bodies. We first consider the data gaps and the elements (water chemistry, ecology, hydromorphology) to be addressed, in order to define where citizen science could best make an impact. We review examples of tools and methods that are appropriate for small water bodies, based on experience from a selection of freshwater citizen science projects, and the support that is needed for effective and sustained small water body projects across Europe.
Collapse
Affiliation(s)
- M. Kelly-Quinn
- School of Biology and Environmental Science & UCD Earth Institute, Dublin, Ireland
| | | | - S. Brooks
- Department Life Sciences, Natural History Museum, London, UK
| | - P. Fortuño
- FEHM (Freshwater Ecology, Hydrology and Management), Department of Evolutionary Biology, Ecology and Environmental Sciences, & Institut de Recerca de la Biodiversitat (IRBio), University of Barcelona, Barcelona, Spain
| | - S. Hegarty
- DCU Water Institute, Dublin City University, Dublin, Ireland
| | | | - F. Regan
- DCU Water Institute, Dublin City University, Dublin, Ireland
- School of Chemical Sciences, Dublin City University, Dublin, Dublin, Ireland
| |
Collapse
|
2
|
Nance D, Lyon D, Hegarty S, Falchetto R, Barman-Aksözen J, Matos JE, Meninger S, Lombardelli S, Dickey A. PB2354: THE IMPACT OF ACUTE HEPATIC PORPHYRIA ON MENTAL HEALTH: RESULTS FROM THE PORPHYRIA WORLDWIDE PATIENT EXPERIENCE RESEARCH (POWER) STUDY. Hemasphere 2022. [PMCID: PMC9429844 DOI: 10.1097/01.hs9.0000852240.72002.e6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
3
|
DiCarlo M, Myers P, Daskalakis C, Shimada A, Hegarty S, Zeigler-Johnson C, Juon HS, Barta J, Myers RE. Outreach to primary care patients in lung cancer screening: A randomized controlled trial. Prev Med 2022; 159:107069. [PMID: 35469777 DOI: 10.1016/j.ypmed.2022.107069] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 09/21/2021] [Revised: 02/11/2022] [Accepted: 04/17/2022] [Indexed: 11/29/2022]
Abstract
Current guidelines recommend annual lung cancer screening (LCS), but rates are low. The current study evaluated strategies to increase LCS. This study was a randomized controlled trial designed to evaluate the effects of patient outreach and shared decision making (SDM) about LCS among patients in four primary care practices. Patients 50 to 80 years of age and at high risk for lung cancer were randomized to Outreach Contact plus Decision Counseling (OC-DC, n = 314), Outreach Contact alone (OC, n = 314), or usual care (UC, n = 1748). LCS was significantly higher in the combined OC/OC-DC group versus UC controls (5.5% vs. 1.8%; hazard ratio, HR = 3.28; 95% confidence interval, CI: 1.98 to 5.41; p = 0.001). LCS was higher in the OC-DC group than in the OC group, although not significantly so (7% vs. 4%, respectively; HR = 1.75; 95% CI: 0.86 to 3.55; p = 0.123). LCS referral/scheduling was also significantly higher in the OC/OC-DC group compared to controls (11% v. 5%; odds ratio, OR = 2.02; p = 0.001). We observed a similar trend for appointment keeping, but the effect was not statistically significant (86% v. 76%; OR = 1.93; p = 0.351). Outreach contacts significantly increased LCS among primary care patients. Research is needed to assess the additional value of SDM on screening uptake.
Collapse
Affiliation(s)
- Melissa DiCarlo
- Division of Population Science, Department of Medical Oncology, Thomas Jefferson University, 834 Chestnut St., Philadelphia, PA 19107, United States of America
| | - Pamela Myers
- Division of Population Science, Department of Medical Oncology, Thomas Jefferson University, 834 Chestnut St., Philadelphia, PA 19107, United States of America
| | - Constantine Daskalakis
- Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, 1015 Chestnut St. Suite 520, Philadelphia, PA 19107, United States of America
| | - Ayako Shimada
- Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, 1015 Chestnut St. Suite 520, Philadelphia, PA 19107, United States of America
| | - Sarah Hegarty
- Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, 1015 Chestnut St. Suite 520, Philadelphia, PA 19107, United States of America
| | - Charnita Zeigler-Johnson
- Division of Population Science, Department of Medical Oncology, Thomas Jefferson University, 834 Chestnut St., Philadelphia, PA 19107, United States of America
| | - Hee-Soon Juon
- Division of Population Science, Department of Medical Oncology, Thomas Jefferson University, 834 Chestnut St., Philadelphia, PA 19107, United States of America
| | - Julie Barta
- The Jane and Leonard Korman Respiratory Institute, Division of Pulmonary and Critical Care Medicine, Thomas Jefferson University, 834 Walnut St., Philadelphia, PA 19107, United States of America
| | - Ronald E Myers
- Division of Population Science, Department of Medical Oncology, Thomas Jefferson University, 834 Chestnut St., Philadelphia, PA 19107, United States of America.
| |
Collapse
|
4
|
Hegarty S, Hardcastle N, Korte J, Kron T, Everitt S, Rahim S, Hegi-Johnson F, Franich R. Please Place Your Seat in the Full Upright Position: A Technical Framework for Landing Upright Radiation Therapy in the 21 st Century. Front Oncol 2022; 12:821887. [PMID: 35311128 PMCID: PMC8929673 DOI: 10.3389/fonc.2022.821887] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 11/24/2021] [Accepted: 01/27/2022] [Indexed: 12/20/2022] Open
Abstract
Delivering radiotherapy to patients in an upright position can allow for increased patient comfort, reduction in normal tissue irradiation, or reduction of machine size and complexity. This paper gives an overview of the requirements for the delivery of contemporary arc and modulated radiation therapy to upright patients. We explore i) patient positioning and immobilization, ii) simulation imaging, iii) treatment planning and iv) online setup and image guidance. Treatment chairs have been designed to reproducibly position seated patients for treatment and can be augmented by several existing immobilisation systems or promising emerging technologies such as soft robotics. There are few solutions for acquiring CT images for upright patients, however, cone beam computed tomography (CBCT) scans of upright patients can be produced using the imaging capabilities of standard Linacs combined with an additional patient rotation device. While these images will require corrections to make them appropriate for treatment planning, several methods indicate the viability of this approach. Treatment planning is largely unchanged apart from translating gantry rotation to patient rotation, allowing for a fixed beam with a patient rotating relative to it. Rotation can be provided by a turntable during treatment delivery. Imaging the patient with the same machinery as used in treatment could be advantageous for online plan adaption. While the current focus is using clinical linacs in existing facilities, developments in this area could also extend to lower-cost and mobile linacs and heavy ion therapy.
Collapse
Affiliation(s)
- Sarah Hegarty
- School of Science, RMIT University, Melbourne, VIC, Australia.,Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Nicholas Hardcastle
- Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW, Australia.,Sir Peter MacCallum Department of Oncology, Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Parkville, VIC, Australia
| | - James Korte
- Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Department of Biomedical Engineering, School of Engineering, University of Melbourne, Melbourne, VIC, Australia
| | - Tomas Kron
- Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW, Australia.,Sir Peter MacCallum Department of Oncology, Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Parkville, VIC, Australia
| | - Sarah Everitt
- Sir Peter MacCallum Department of Oncology, Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Parkville, VIC, Australia.,Department of Radiation Therapy, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Sulman Rahim
- Department of Radiation Therapy, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Fiona Hegi-Johnson
- Sir Peter MacCallum Department of Oncology, Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Parkville, VIC, Australia.,Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Rick Franich
- School of Science, RMIT University, Melbourne, VIC, Australia.,Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| |
Collapse
|
5
|
Giri VN, Bowler N, Hegarty S, Gross L, Hyatt C, Kelly WK, Gomella LG. Video vs. in-person genetic counseling for men considering germline prostate cancer testing: A patient-choice study. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.1577] [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: 11/20/2022] Open
Abstract
1577 Background: Germline testing (GT) for prostate cancer (PCA) is rapidly increasing with higher demand for genetic counseling (GC). Alternate GC strategies need to be studied to address pretest informed consent. Here we conducted a patient-choice study of pretest video-based genetic education (VBGE) or in-person GC (IPGC) and assessed men’s preference and patient-reported outcomes from the first cohort of the Evaluation and Management for Prostate Oncology, Wellness, and Risk (EMPOWER) study. Methods: Eligibility for EMPOWER includes any male with PCA or at-risk for PCA based on family history or African American race. Men may choose pretest IPGC or VBGE. All receive results by a genetic professional. Demographics and PCA features were collected at baseline. The following outcomes and scales were assessed: baseline anxiety (GAD-7 scale), change in cancer genetics knowledge from baseline (Giri 2019), decisional conflict for GT (O’Connor 1993), and satisfaction (DeMarco 2004). Understanding of personal GT results was assessed after disclosure (Giri 2019). Descriptive statistics summarized results with counts and percentages for categorical variables and mean and standard deviation for continuous variables. Data were compared with Fisher’s exact, Chi-squared, or Wilcoxon two-sample tests, as appropriate. Mean change in cancer genetics knowledge was compared with t-tests. Significance level was set a priori at 0.05. All analyses were performed with SAS 9.4 (Cary, NC). Results: At the time of this analysis, 94 men were enrolled. Characteristics of the cohort were: White (88.3%), bachelor’s degree (67%), PCA diagnosis (93%), mean age of consent 59 years (IPGC) and 61 years (VBGE), Gleason > = 8 (32%), and > = T3 (31%). The majority preferred VBGE (77%) vs. IPGC (23%). Men who opted for IPGC had lower educational levels ( < = high school/GED) (18% IPGC vs 7% VBGE) and reported higher baseline anxiety (45% IPGC vs. 24% VBGE). Cancer genetics knowledge improved significantly with IPGC vs. VBGE (+2.5 vs +0.8; p < 0.01). No differences were observed in decisional conflict, satisfaction, or understanding of personal GT results between IPGC vs. VBGE. Both groups had high rates of GT uptake (IPGC 91%, VBGE 93%). Pathogenic mutations were identified in 15% in IPGC group and 10.4% in VBGE group. Conclusions: A substantial proportion of men opted for VBGE, and results suggest that VBGE is comparable to IPGC for men considering PCA GT. IPGC may be more suitable for men with lower knowledge of cancer genetics and greater levels or anxiety. Further study is warranted.
Collapse
Affiliation(s)
- Veda N. Giri
- Departments of Medical Oncology, Cancer Biology, and Urology, Cancer Risk Assessment and Clinical Cancer Genetics Program, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Nicholas Bowler
- Department of Urology, Thomas Jefferson University, Philadelphia, PA
| | - Sarah Hegarty
- Thomas Jefferson University Hospital, Philadelphia, PA
| | - Laura Gross
- Thomas Jefferson University, Philadelphia, PA
| | | | - William Kevin Kelly
- Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, PA
| | - Leonard G. Gomella
- Department of Urology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| |
Collapse
|
6
|
Rahim S, Korte J, Hardcastle N, Hegarty S, Kron T, Everitt S. Upright Radiation Therapy-A Historical Reflection and Opportunities for Future Applications. Front Oncol 2020; 10:213. [PMID: 32158693 PMCID: PMC7052284 DOI: 10.3389/fonc.2020.00213] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 12/17/2019] [Accepted: 02/07/2020] [Indexed: 01/08/2023] Open
Abstract
Since the early days of megavoltage Radiation Therapy (RT), the potential of delivering treatment to a sub group of patients in an upright position has been recognized. Compared to lying horizontally, treating patients in an upright position offers potential benefits in terms of patient comfort especially for patients experiencing dyspnoea and saliva accumulation when lying down. Dosimetric benefits can also be gained from changes in the volume and location of lungs and heart in an upright position, which are potentially advantageous for clinical situations including Hodgkin's disease, lung and breast malignancies. Since the 1950's, upright stabilization mechanisms have ranged from standalone chair based apparatus to couch-top attachments with increasingly customizable solutions. The introduction of Computed-Tomography (CT) based three-dimensional (3D) dosimetry in the 1980's−90's necessitated image acquisition in a horizontal position (supine or prone), significantly reducing options for alternative patient positioning and upright techniques. Despite this, upright techniques have still been utilized where clinically indicated for palliative and novel approaches often involving non-standard treatment scenarios. More recently, a small number of centers have reported on specialized equipment capable of acquiring planning data with the patient in a vertical position. The possibility of acquiring planning quality Cone Beam CT (CBCT) on linear accelerators has recently reinvigorated the potential to deliver highly accurate and targeted treatments to patients in an upright position. This paper reflects on the historical applications of upright RT and explores new possibilities for this technology in modern RT departments.
Collapse
Affiliation(s)
- Sulman Rahim
- Department of Radiation Therapy, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - James Korte
- Department of Biomedical Engineering, School of Engineering, University of Melbourne, Melbourne, VIC, Australia.,Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Nicholas Hardcastle
- Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW, Australia
| | - Sarah Hegarty
- Department of Physics, RMIT University, Melbourne, VIC, Australia.,Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Tomas Kron
- Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW, Australia.,Sir Peter MacCallum Department of Oncology, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, VIC, Australia
| | - Sarah Everitt
- Department of Radiation Therapy, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Sir Peter MacCallum Department of Oncology, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, VIC, Australia
| |
Collapse
|
7
|
Daskalakis C, DiCarlo M, Hegarty S, Gudur A, Vernon SW, Myers RE. Predictors of overall and test-specific colorectal Cancer screening adherence. Prev Med 2020; 133:106022. [PMID: 32045616 PMCID: PMC7415480 DOI: 10.1016/j.ypmed.2020.106022] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 02/06/2020] [Accepted: 02/07/2020] [Indexed: 01/18/2023]
Abstract
This study investigated predictors of overall and test-specific colorectal cancer screening (CRCS). Stool blood test (SBT) and/or colonoscopy screening were offered to primary care patients in two randomized controlled trials which assessed the impact of behavioral interventions on screening. Data were obtained through surveys and electronic medical records. Among 1942 participants, 646 (33%) screened. Exposure to interventions was associated with higher overall CRCS by twofold to threefold; older age, African American race, being married, and having a higher screening decision stage were also associated with higher overall CRCS (odds ratios = 1.30, 1.31, 1.34, and 5.59, respectively). Intervention, older age, female gender, and being married were associated with higher SBT adherence, while preference for colonoscopy was associated with lower SBT adherence. Intervention and higher decision stage were associated with higher colonoscopy adherence, while preference for SBT was associated with lower colonoscopy adherence. Among older individuals, African Americans had higher overall CRCS than whites, but this was not true among younger individuals (interaction p = .041). The higher screening adherence of African Americans over whites was due to stronger screening with a non-preferred test, i.e., higher SBT adherence only among individuals who preferred colonoscopy and higher colonoscopy adherence only among individuals who preferred SBT. Intervention exposure, sociodemographic background, and screening decision stage predicted overall CRCS adherence. Gender and test preference also affected test-specific screening adherence. Interactions involving race and test preference suggest that it is important to provide both colonoscopy and SBT screening options to patients, particularly African Americans.
Collapse
Affiliation(s)
- Constantine Daskalakis
- Thomas Jefferson University, Department of Pharmacology & Experimental Therapeutics, Division of Biostatistics, United States of America.
| | - Melissa DiCarlo
- Thomas Jefferson University, Department of Medical Oncology, Division of Population Science, United States of America
| | - Sarah Hegarty
- Thomas Jefferson University, Department of Pharmacology & Experimental Therapeutics, Division of Biostatistics, United States of America
| | - Anuragh Gudur
- Drexel University College of Medicine, United States of America
| | - Sally W Vernon
- University of Texas School of Public Health, Center for Health Promotion and Prevention Research, Division of Health Promotion and Behavioral Sciences, United States of America
| | - Ronald E Myers
- Thomas Jefferson University, Department of Medical Oncology, Division of Population Science, United States of America
| |
Collapse
|
8
|
Mintzer S, Yi M, Hegarty S, Maio V, Keith S. Hyperlipidemia in patients newly treated with anticonvulsants: A population study. Epilepsia 2020; 61:259-266. [DOI: 10.1111/epi.16420] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 11/18/2019] [Accepted: 12/10/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Scott Mintzer
- Department of Neurology Thomas Jefferson University Philadelphia Pennsylvania
| | - Misung Yi
- Division of Biostatistics Department of Pharmacology Thomas Jefferson University Philadelphia Pennsylvania
| | - Sarah Hegarty
- Division of Biostatistics Department of Pharmacology Thomas Jefferson University Philadelphia Pennsylvania
| | - Vittorio Maio
- School of Population Health Thomas Jefferson University Philadelphia Pennsylvania
| | - Scott Keith
- Division of Biostatistics Department of Pharmacology Thomas Jefferson University Philadelphia Pennsylvania
| |
Collapse
|
9
|
Laufer T, Lerner B, Petrich A, Quinn AM, Ernst L, Roop A, Knoblauch J, Leasure NC, Jaslow RJ, Hegarty S, Leader A, Barsevick A. Evaluation of a Technology-Based Survivor Care Plan for Breast Cancer Survivors: Pre-Post Pilot Study. JMIR Cancer 2019; 5:e12090. [PMID: 31859683 PMCID: PMC6942181 DOI: 10.2196/12090] [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: 09/06/2018] [Revised: 05/21/2019] [Accepted: 09/03/2019] [Indexed: 11/13/2022] Open
Abstract
Background As of 2016, almost 16 million individuals were cancer survivors, including over 3.5 million survivors of breast cancer. Because cancer survivors are living longer and have unique health care needs, the Institute of Medicine proposed a survivor care plan as a way to alleviate the many medical, emotional, and care coordination problems of survivors. Objective This pilot study for breast cancer survivors was undertaken to: (1) examine self-reported changes in knowledge, confidence, and activation from before receipt to after receipt of a survivor care plan; and (2) describe survivor preferences for, and satisfaction with, a technology-based survivor care plan. Methods A single group pretest-posttest design was used to study breast cancer survivors in an academic cancer center and a community cancer center during their medical visit after they completed chemotherapy. The intervention was a technology-based survivor care plan. Measures were taken before, immediately after, and 1 month after receipt of the survivor care plan. Results A total of 38 breast cancer survivors agreed to participate in the study. Compared to baseline levels before receipt of the survivor care plan, participants reported increased knowledge both immediately after its receipt at the academic center (P<.001) and the community center (P<.001) as well as one month later at the academic center (P=.002) and the community center (P<.001). Participants also reported increased confidence immediately following receipt of the survivor care plan at the academic center (P=.63) and the community center (P=.003) and one month later at both the academic center (P=.63) and the community center (P<.001). Activation was increased from baseline to post-survivor care plan at both the academic center (P=.05) and community center (P<.001) as well as from baseline to 1-month follow-up at the academic center (P=.56) and the community center (P<.001). Overall, community center participants had lower knowledge, confidence, and activation at baseline compared with academic center participants. Overall, 22/38 (58%) participants chose the fully functional electronic survivor care plan. However, 12/23 (52%) in the community center group chose the paper version compared to 4/15 (27%) in the academic center group. Satisfaction with the format (38/38 participants) and the content (37/38 participants) of the survivor care plan was high for both groups. Conclusions This study provides evidence that knowledge, confidence, and activation of survivors were associated with implementation of the survivor care plan. This research agrees with previous research showing that cancer survivors found the technology-based survivor care plan to be acceptable. More research is needed to determine the optimal approach to survivor care planning to ensure that all cancer survivors can benefit from it.
Collapse
Affiliation(s)
- Talya Laufer
- Division of Population Science, Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA, United States
| | - Bryan Lerner
- Division of Population Science, Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA, United States
| | - Anett Petrich
- Division of Population Science, Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA, United States
| | - Anna M Quinn
- Division of Population Science, Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA, United States
| | - Leah Ernst
- McGlinn Cancer Institute, Reading Health System, West Reading, PA, United States
| | - Alicin Roop
- McGlinn Cancer Institute, Reading Health System, West Reading, PA, United States
| | - Janet Knoblauch
- McGlinn Cancer Institute, Reading Health System, West Reading, PA, United States
| | - Nick C Leasure
- McGlinn Cancer Institute, Reading Health System, West Reading, PA, United States
| | - Rebecca J Jaslow
- Department of Medical Oncology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States
| | - Sarah Hegarty
- Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA, United States
| | - Amy Leader
- Division of Population Science, Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA, United States
| | - Andrea Barsevick
- Division of Population Science, Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA, United States
| |
Collapse
|
10
|
Hark LA, Adeghate J, Katz LJ, Ulas M, Waisbourd M, Maity A, Zhan T, Hegarty S, Leiby BE, Pasquale LR, Leite S, Saaddine JB, Haller JA, Myers JS. Philadelphia Telemedicine Glaucoma Detection and Follow-Up Study: Cataract Classifications Following Eye Screening. Telemed J E Health 2019; 26:992-1000. [PMID: 31721654 DOI: 10.1089/tmj.2019.0170] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 11/12/2022] Open
Abstract
Background: Cataracts are a major cause of visual impairment and blindness in the United States and worldwide. Introduction: Risk factors for cataracts include age over 40 years, smoking, diabetes, low socioeconomic status, female sex, steroid use, ocular trauma, genetic factors, and exposure to ultraviolet-B light. Community-based telemedicine vision screenings can be an efficient method for detecting cataracts in underserved populations. The Philadelphia Telemedicine Glaucoma Detection and Follow-Up Study reports the prevalence and risk factors for cataracts in individuals screened and examined for glaucoma and other eye diseases. Materials and Methods: A total of 906 high-risk individuals were screened for glaucoma using telemedicine in seven primary care practices and four Federally Qualified Health Centers in Philadelphia. Participants with suspicious nerves or other abnormalities on fundus photographs, unreadable images, and ocular hypertension returned for an eye examination with an ophthalmologist at the same community location. Results: Of the participants screened through telemedicine, 347 (38.3%) completed a follow-up eye examination by an ophthalmologist. Of these, 267 (76.9%) were diagnosed with cataracts, of which 38 (14.2%) had visually significant cataracts. Participants who were diagnosed with visually significant cataract were more likely to be older (p < 0.001), have diabetes (p = 0.003), and worse visual acuity (p < 0.001). Discussion: Our study successfully detected and confirmed cataracts in a targeted, underserved urban population at high risk for eye disease. Conclusions: Telemedicine programs offer an opportunity to identify and refer individuals who would benefit from continuous follow-up eye care and treatment to improve visual function and quality of life.
Collapse
Affiliation(s)
- Lisa A Hark
- Wills Eye Hospital, Glaucoma Research Center, Philadelphia, Pennsylvania, USA.,Columbia University Vagelos College of Physicians and Surgeons, Edward S. Harkness Eye Institute, New York, New York, USA
| | - Jennifer Adeghate
- University of Pittsburgh, Department of Ophthalmology, Pittsburgh, Pennsylvania, USA
| | - L Jay Katz
- Wills Eye Hospital, Glaucoma Research Center, Philadelphia, Pennsylvania, USA.,Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Mikdat Ulas
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Michael Waisbourd
- Division of Ophthalmology, Tel-Aviv Medical Center, Tel-Aviv University Sackler Faculty of Medicine, Tel-Aviv, Israel
| | - Alisha Maity
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Tingting Zhan
- Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Sidney Kimmel Medical College, Philadelphia, Pennsylvania, USA
| | - Sarah Hegarty
- Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Sidney Kimmel Medical College, Philadelphia, Pennsylvania, USA
| | - Benjamin E Leiby
- Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Sidney Kimmel Medical College, Philadelphia, Pennsylvania, USA
| | - Louis R Pasquale
- Icahn School of Medicine at Mount Sinai, Department of Ophthalmology, New York, New York, USA
| | - Stela Leite
- Wills Eye Hospital, Glaucoma Research Center, Philadelphia, Pennsylvania, USA
| | - Jinan B Saaddine
- Centers for Disease Control and Prevention, Division of Diabetes and Translational Research, Vision Health Initiative, Atlanta, Georgia, USA
| | - Julia A Haller
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.,Wills Eye Hospital, Ophthalmologist-in-Chief, Philadelphia, Pennsylvania, USA
| | - Jonathan S Myers
- Wills Eye Hospital, Glaucoma Research Center, Philadelphia, Pennsylvania, USA.,Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| |
Collapse
|
11
|
Hark LA, Radakrishnan A, Madhava M, Anderson-Quiñones C, Fudemberg S, Robinson D, Myers JS, Zhan T, Adeghate J, Hegarty S, Leite S, Leiby BE, Stempel S, Katz LJ. Awareness of ocular diagnosis, transportation means, and barriers to ophthalmology follow-up in the Philadelphia Telemedicine Glaucoma Detection and Follow-up Study. Soc Work Health Care 2019; 58:651-664. [PMID: 31120381 DOI: 10.1080/00981389.2019.1614711] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 03/15/2019] [Accepted: 04/22/2019] [Indexed: 06/09/2023]
Abstract
Purpose: The purpose of this study was to assess factors affecting follow-up eye care in participants enrolled in the Philadelphia Telemedicine Glaucoma Detection and Follow-up Study, such as awareness of ocular diagnosis, availability of transportation methods, and reasons for missing eye care appointments. Methods: The sample included 172 participants who were randomized to the intervention group and contacted by the social worker. Results: A total of 155 participants completed the assessment form, which was used as an instrument to assess factors affecting adherence to follow-up eye care. The main reasons for missing eye exam appointments were feeling ill (38.1%, n = 59) and forgetting the appointment (34.2%, n = 53). In addition, 45 (29.2%) participants were unaware of or did not comprehend the severity of their ocular diagnosis. Common methods of transportation included public transportation (31.6%, n = 49), driving (29.7%, n = 46), and being driven (27.7%, n = 43) to their appointment. Conclusion: These results suggest that individuals in need of eye care may benefit from additional assistance of a social worker regarding ongoing eye exam appointment reminders and in-depth explanation of their ocular diagnosis.
Collapse
Affiliation(s)
- Lisa A Hark
- a Wills Eye Hospital, Glaucoma Research Center , Philadelphia , PA , USA
- b Department of Ophthalmology , Columbia University Irving Medical Center , New York , NY , USA
| | - Anjithaa Radakrishnan
- c Sidney Kimmel Medical College, Thomas Jefferson University , Philadelphia , PA , USA
| | - Malika Madhava
- c Sidney Kimmel Medical College, Thomas Jefferson University , Philadelphia , PA , USA
| | - Catherine Anderson-Quiñones
- a Wills Eye Hospital, Glaucoma Research Center , Philadelphia , PA , USA
- c Sidney Kimmel Medical College, Thomas Jefferson University , Philadelphia , PA , USA
| | - Scott Fudemberg
- a Wills Eye Hospital, Glaucoma Research Center , Philadelphia , PA , USA
- c Sidney Kimmel Medical College, Thomas Jefferson University , Philadelphia , PA , USA
| | - Debra Robinson
- a Wills Eye Hospital, Glaucoma Research Center , Philadelphia , PA , USA
| | - Jonathan S Myers
- a Wills Eye Hospital, Glaucoma Research Center , Philadelphia , PA , USA
- c Sidney Kimmel Medical College, Thomas Jefferson University , Philadelphia , PA , USA
| | - Tingting Zhan
- d Department of Pharmacology and Experimental Therapeutics, Division of Biostatistics , Thomas Jefferson University , Philadelphia , PA , USA
| | - Jennifer Adeghate
- e Department of Ophthalmology , Weill Cornell Medical College , New York , NY , USA
| | - Sarah Hegarty
- d Department of Pharmacology and Experimental Therapeutics, Division of Biostatistics , Thomas Jefferson University , Philadelphia , PA , USA
| | - Stela Leite
- a Wills Eye Hospital, Glaucoma Research Center , Philadelphia , PA , USA
| | - Benjamin E Leiby
- d Department of Pharmacology and Experimental Therapeutics, Division of Biostatistics , Thomas Jefferson University , Philadelphia , PA , USA
| | - Stella Stempel
- b Department of Ophthalmology , Columbia University Irving Medical Center , New York , NY , USA
| | - L Jay Katz
- a Wills Eye Hospital, Glaucoma Research Center , Philadelphia , PA , USA
- c Sidney Kimmel Medical College, Thomas Jefferson University , Philadelphia , PA , USA
| |
Collapse
|
12
|
Lu-Yao GL, Nikita N, Johnson JM, Keith SW, Wen KY, Zinner R, Ghosh N, Banks J, Hegarty S, Wilson M. Pretreatment steroid use and completion of immunotherapy: A population-based study. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.9567] [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: 11/20/2022] Open
Abstract
9567 Background: The relationship between immunosuppressants and immunotherapy (IO) is an active area of research. Here we study the impact of pre-treatment steroid use on the completion of ipilimumab (ipi) therapy. Methods: This population-based study identified patients diagnosed with melanoma and treated with ipi (brand name Yervoy) in 2010-2014 from the linked Surveillance, Epidemiology and End Result-Medicare files. “Completion of IO on time” was defined as receiving 4 cycles of IO within 90 days. Otherwise, the patients were considered to have delayed or incomplete IO. The frequencies of patients completing each dose, up to 4 doses were tabulated. Exact Clopper-Pearson 95% confidence intervals (CI) were computed for prevalence estimates. A crude relative risk (RR) for completing IO was calculated. Results: We identified 1,205 melanoma patients treated with ipi with a median age of 71 years. Among 709 patients with no pre-treatment steroids, 35.7% had completed 4th dose of IO, compared to 20.3% of patients who received pre-treatment steroids within 1 month of IO (Table). In these patients, having no exposure to steroids in the year prior to initiating IO was associated with a 28% increased probability of completing the IO regimen (RR=1.28, 95% CI: 1.07-1.53). Conclusions: This large scale real-world study demonstrated both the overall completion rate of ipi in melanoma patients as well as the negative impact of pre-treatment steroids on rate of treatment completion. Further studies on treatment outcomes associated with pre-IO steroids use are warranted. [Table: see text]
Collapse
Affiliation(s)
| | | | | | - Scott W. Keith
- Thomas Jefferson University, Department of Pharmacology & Experimental Therapeutics, Philadelphia, PA
| | | | - Ralph Zinner
- Thomas Jefferson University Hospital, Department of Medical Oncology, Philadelphia, PA
| | | | | | - Sarah Hegarty
- Thomas Jefferson University Hospital, Philadelphia, PA
| | | |
Collapse
|
13
|
Giri VN, Chandrasekar T, Hegarty S, Gross L, Leong JY, Gomella LG. Cascade testing of men with prostate cancer in families with a spectrum of inherited cancers: Importance of attention to race. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.7_suppl.75] [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: 11/20/2022] Open
Abstract
75 Background: Prostate cancer (PCa) is increasingly recognized as a part of hereditary cancer syndromes (HCS) with implications for cascade genetic testing (CGT) of men with PCa in these families. However, race-specific rates of HCS in probands presenting for inherited cancer assessment who report a family history (FHx) of PCa is not known has implications for CGT of men with PCa. Methods: A prospectively maintained genetic testing database at a tertiary care cancer genetics program was queried for all probands reporting a PCa FHx. Pedigrees were analyzed for three HCS linked with PCa: hereditary breast and ovarian syndrome (HBOC), classic Hereditary PCa (HPC), and Lynch syndrome (LS). Associations between HCS and race were evaluated using Fisher’s exact test. Each HCS was evaluated for potential genetic link to the male relative with PCa and associations with race were tested using Fisher’s exact test. Results: 345 probands met inclusion criteria: 53 African-American (AA), 292 Caucasian (Wh), 74.5% female. Proband cancer diagnoses included breast (43.2%), prostate (12.8%), pancreatic (3.8%), ovarian (3.2%), and colorectal (2.9%). Overall, 63.8% of probands met criteria for ≥ 1 HCS based on personal and FHx. Male relatives with PCa in these families with potential genetic link to HCS were found in 75.5% AA families and 61.6% Wh families. HBOC was identified in a higher percentage of AA families with a potentially-linked male relative with PCa compared to Wh families (69.8% vs. 52.4%, respectively; p=0.051). Among probands with HCS potentially linked to PCa (n = 169), 19.5% were found to carry a genetic mutation in a cancer risk gene (17.9% AA and 19.9% Wh). BRCA1/2 mutations accounted for all mutations identified in AA probands and 66.7% of Wh probands. Conclusions: A significant percentage of patients who present for inherited cancer assessment report a FHx of PCa potentially linked with a HCS. Importantly, AA probands with a PCa FHx have comparable rates of HCS as Wh probands, with potentially higher rates of HBOC in AA families accounted for by BRCA mutations. Cascade testing of men with PCa in families with HCS is crucial with a need to address any race-specific barriers.
Collapse
Affiliation(s)
- Veda N. Giri
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | | | - Sarah Hegarty
- Thomas Jefferson University Hospital, Philadelphia, PA
| | - Laura Gross
- Thomas Jefferson University, Philadelphia, PA
| | - Joon Yau Leong
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Leonard G. Gomella
- Department of Urology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| |
Collapse
|
14
|
Hark LA, Myers JS, Ines A, Jiang A, Rahmatnejad K, Zhan T, Leiby BE, Hegarty S, Fudemberg SJ, Mantravadi AV, Waisbourd M, Henderer JD, Burns C, Divers M, Molineaux J, Pizzi LT, Murchison AP, Saaddine J, Pasquale LR, Haller JA, Katz LJ. Philadelphia Telemedicine Glaucoma Detection and Follow-up Study: confirmation between eye screening and comprehensive eye examination diagnoses. Br J Ophthalmol 2019; 103:1820-1826. [PMID: 30770354 DOI: 10.1136/bjophthalmol-2018-313451] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 10/26/2018] [Revised: 01/09/2019] [Accepted: 01/16/2019] [Indexed: 11/03/2022]
Abstract
AIMS To evaluate agreement between ocular findings of a telemedicine eye screening (visit 1) with diagnoses of a comprehensive eye examination (visit 2). METHODS A primary care practice (PCP)-based telemedicine screening programme incorporating fundus photography, intraocular pressure (IOP) and clinical information was conducted. Eligible individuals were African American, Hispanic/Latino or Asian over the age of 40; Caucasian individuals over age 65; and adults of any ethnicity over age 40 with a family history of glaucoma or diabetes. Participants with abnormal images or elevated IOP were invited back for a complete eye examination. Both visit 1 and visit 2 were conducted at participants' local PCP. Ocular findings at visit 1 and eye examination diagnoses at visit 2 are presented, including a cost analysis. RESULTS Of 906 participants who attended visit 1, 536 were invited to visit 2 due to ocular findings or unreadable images. Among the 347 (64.9%) who attended visit 2, 280 (80.7%) were diagnosed with at least one ocular condition. Participants were predominately women (59.9%) and African American (65.6%), with a mean age (±SD) of 60.6±11.0 years. A high diagnostic confirmation rate (86.0%) was found between visit 1 and visit 2 for any ocular finding. Of 183 with suspicious nerves at visit 1, 143 (78.1%) were diagnosed as glaucoma or glaucoma suspects at visit 2. CONCLUSIONS This screening model may be adapted and scaled nationally and internationally. Referral to an ophthalmologist is warranted if abnormal or unreadable fundus images are detected or IOP is >21 mm Hg. TRIAL REGISTRATION NUMBER NCT02390245.
Collapse
Affiliation(s)
- Lisa A Hark
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, Pennsylvania, USA .,Ophthalmology, Columbia University Irving Medical Center, New York, New York, USA
| | - Jonathan S Myers
- Glaucoma Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA.,Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Andrew Ines
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Alicia Jiang
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Kamran Rahmatnejad
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - Tingting Zhan
- Division of Biostatistics, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Benjamin E Leiby
- Division of Biostatistics, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Sarah Hegarty
- Division of Biostatistics, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Scott J Fudemberg
- Glaucoma Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA.,Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Anand V Mantravadi
- Glaucoma Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA.,Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | - Jeffrey D Henderer
- Ophthalmology, Temple University Hospital, Philadelphia, Pennsylvania, USA
| | - Christine Burns
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - Meskerem Divers
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - Jeanne Molineaux
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - Laura T Pizzi
- School of Pharmacy, Rutgers University, Piscataway, New Jersey, USA
| | - Ann P Murchison
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.,Emergency Department, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - Jinan Saaddine
- Centers for Disease Control and Prevention, Division of Diabetes Translation, Vision Health Initiative, Atlanta, Georgia, USA
| | - Louis R Pasquale
- Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Julia A Haller
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.,Wills Eye Hospital, Ophthalmologist-in-Chief, Philadelphia, Pennsylvania, USA
| | - L Jay Katz
- Glaucoma Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA.,Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| |
Collapse
|
15
|
Iadanza S, Bakoz AP, Singaravelu PKJ, Panettieri D, Schulz SA, Devarapu GCR, Guerber S, Baudot C, Boeuf F, Hegarty S, O'Faolain L. Thermally stable hybrid cavity laser based on silicon nitride gratings. Appl Opt 2018; 57:E218-E223. [PMID: 30117905 DOI: 10.1364/ao.57.00e218] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 06/28/2018] [Indexed: 05/26/2023]
Abstract
In this paper, we show the experimental results of a thermally stable Si3N4 external cavity (SiN EC) laser with high power output and the lowest SiN EC laser threshold to our knowledge. The device consists of a 250 μm sized reflective semiconductor optical amplifier butt-coupled to a passive chip based on a series of Si3N4 Bragg gratings acting as narrow reflectors. A threshold of 12 mA has been achieved, with a typical side-mode suppression ratio of 45 dB and measured power output higher than 3 mW. Furthermore, we achieved a mode-hop free-lasing regime in the range of 15-62 mA and wavelength thermal stability up to 80°C. This solves the challenges related to cavity resonances' thermal shift and shows the possibility for this device to be integrated in dense wavelength-division multiplexing (WDM) and heat-intensive optical interconnects technologies.
Collapse
|
16
|
Lu-Yao GL, Nightingale G, Nikita N, Patel SA, Gandhi K, Leiby B, Hegarty S, Barsevick AM, Padron N, Rebbeck T, Chapman AE, Gomella LG, Kelly WK. Clinical outcomes following androgen receptor axis therapies (ARAT) among men with prostate cancer (PCa) having major cardiovascular diseases (CVDs) or extreme polypharmacy (EPP): A population based study. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.5056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Ginah Nightingale
- Jefferson School of Pharmacy, Thomas Jefferson University, Philadelphia, PA
| | | | | | | | - Benjamin Leiby
- Thomas Jefferson University, Department of Pharmacology and Experimental Therapeutics, Philadelphia, PA, US
| | - Sarah Hegarty
- Thomas Jefferson University Hospital, Philadelphia, PA
| | | | - Norma Padron
- Lankenau Institute for Medical Research, Philadelphia, PA
| | - Timothy Rebbeck
- Harvard University, T.H. Chan School of Public Health and Dana Farber Cancer Institute, Boston, MA
| | | | - Leonard G. Gomella
- Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, PA
| | - William Kevin Kelly
- Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, PA
| |
Collapse
|
17
|
Giri VN, Hegarty S, Obeid E, Hyatt C, Fang CY, Leader A. Knowledge and understanding of genetic test results in men undergoing multigene testing for inherited prostate cancer. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.1516] [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: 11/20/2022] Open
Abstract
1516 Background: Genetic counseling (GC) for prostate cancer (PCA) risk is an emerging field, with limited insights regarding needs of males considering genetic testing (GT). Genetic Evaluation of Men is a prospective multigene testing study to identify inherited mutations linked to PCA, with testing following GC. We surveyed men pre-GT and post-GT on knowledge of cancer risk and genetics (KCRG) and understanding of personal GT results to identify GC needs. Methods: Eligibility for males affected or high-risk for PCA encompass age, race, family history (FH), and PCA stage/grade. Demographic, clinical, and FH data were obtained from participants and medical records. Pre-GT survey included questions on KCRG (15 items) and health literacy/numeracy (6 items). Post-GT survey additionally included understanding of GT results (9 items). Personal and FH were categorized into three hereditary cancer syndromes (HCS) linked to PCA. Factors associated with baseline KCRG were assessed by univariable models followed by multivariable linear regression. McNemar’s test was used to assess concordance of understanding GT results vs. actual results. Results: Among 109 men (mean age 63 years, 81% White, 59% PCA diagnosis) who completed pre- and post-surveys, factors associated with higher pre-test KCRG included meeting HCS criteria (p = 0.006) and higher numeracy (p = 0.025). On multivariable analysis, HCS remained significantly predictive of higher KCRG (p = 0.040). However, of 101 men who responded definitively regarding understanding of personal GT results, 13 responded incorrectly on mutation status indicating significant disagreement with actual results (McNemar’s p < 0.001). Of these 13 men, 12 had > = 1 variant of uncertain significance (VUS). Additionally, 6 men were unsure whether they carried a mutation when their GT results found VUS but no mutations. Conclusions: This is the first report of knowledge and understanding of genetics and cancer risk in the context of multigene testing for PCA. While personal/FH of HCS was associated with higher KCRG, understanding of personal GT results was lacking, and warrants tailored GC strategies for multigene testing for inherited PCA.
Collapse
Affiliation(s)
- Veda N. Giri
- The Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, PA
| | - Sarah Hegarty
- Thomas Jefferson University Hospital, Philadelphia, PA
| | | | | | | | - Amy Leader
- Division of Population Science, Department of Medical Oncology, Philadelphia, PA
| |
Collapse
|
18
|
Myers RE, Wolf T, Shwae P, Hegarty S, Peiper SC, Waldman SA. A survey of physician receptivity to molecular diagnostic testing and readiness to act on results for early-stage colon cancer patients. BMC Cancer 2016; 16:766. [PMID: 27716119 PMCID: PMC5048478 DOI: 10.1186/s12885-016-2812-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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: 10/12/2015] [Accepted: 09/23/2016] [Indexed: 12/20/2022] Open
Abstract
Background We sought to assess physician interest in molecular prognosic testing for patients with early stage colon cancer, and identify factors associated with the likelihood of test adoption. Methods We identified physicians who care for patients with early-stage (pN0) colon cancer patients, mailed them a survey, and analyzed survey responses to assess clinician receptivity to the use of a new molecular test (GUCY2C) that identifies patients at risk for recurrence, and clinician readiness to act on abnormal test results. Results Of 104 eligible potential respondents, 41 completed and returned the survey. Among responding physicians, 56 % were receptive to using the new prognostic test. Multivariable analyses showed that physicians in academic medical centers were significantly more receptive to molecular test use than those in non-academic settings. Forty-one percent of respondents were ready to act on abnormal molecular test results. Physicians who viewed current staging methods as inaccurate and were confident in their capacity to incorporate molecular testing in practice were more likely to say they would act on abnormal test results. Conclusions Physician receptivity to molecular diagnostic testing for early-stage colon cancer patients is likely to be influenced by practice setting and perceptions related to delivering quality care to patients. Trial registration ClinicalTrials.gov Identifier: NCT01972737
Collapse
Affiliation(s)
- Ronald E Myers
- Department of Medical Oncology, Thomas Jefferson University, Benjamin Franklin House, Suite 314, 834 Chestnut St, Philadelphia, PA, 19107, USA.
| | - Thomas Wolf
- Department of Medical Oncology, Thomas Jefferson University, Benjamin Franklin House, Suite 314, 834 Chestnut St, Philadelphia, PA, 19107, USA
| | - Phillip Shwae
- Thomas Jefferson University, 305 South 11th Street, Apt. 4F, Philadelphia, PA, 19107, USA
| | - Sarah Hegarty
- Department of Pharmacology & Experimental Therapeutics, Thomas Jefferson University, 1015 Chestnut Street Building, Suite M-100 Mezzanine, 1015 Chestnut Street, Philadelphia, PA, 19107, USA
| | - Stephen C Peiper
- Department of Pathology, Anatomy and Cell Biology, Thomas Jefferson University, Jeff Hall, Room 279, 1020 Locust St, Philadelphia, PA, 19107, USA
| | - Scott A Waldman
- Department of Pharmacology & Experimental Therapeutics, Thomas Jefferson University, 1015 Chestnut Street Building, Suite M-100 Mezzanine, 1015 Chestnut Street, Philadelphia, PA, 19107, USA
| |
Collapse
|
19
|
Obeid E, Hegarty S, Bealin L, Montgomery S, Gross L, Chen DYT, Giri VN. Hereditary cancer syndromes and prostate cancer development among African American men: The importance of complete family cancer history. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e16625] [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] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Sarah Hegarty
- Thomas Jefferson University Hospital, Philadelphia, PA
| | | | | | | | | | - Veda N. Giri
- The Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| |
Collapse
|
20
|
Ekici F, Loh R, Waisbourd M, Sun Y, Martinez P, Nayak N, Wizov SS, Hegarty S, Hark LA, Spaeth GL. Relationships Between Measures of the Ability to Perform Vision-Related Activities, Vision-Related Quality of Life, and Clinical Findings in Patients With Glaucoma. JAMA Ophthalmol 2016; 133:1377-85. [PMID: 26425961 DOI: 10.1001/jamaophthalmol.2015.3426] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE To our knowledge, few studies have combined an objective measure of vision-related performance (VRP) and subjective measures of vision-related quality of life (VRQoL) with clinically related visual parameters, particularly in a large, prospective, cohort study setting. OBJECTIVE To examine the relationships between clinical visual assessments and both a VRP and 2 self-reported VRQoL measurements. DESIGN, SETTING, AND PARTICIPANTS Patients (N = 161) with moderate-stage glaucoma recruited from the Glaucoma Service at Wills Eye Hospital, Philadelphia, Pennsylvania, were enrolled from May 2012 to May 2014 in an ongoing prospective, 4-year longitudinal observational study. This report includes cross-sectional results from the baseline visit. Patients received a complete ocular examination, automated visual field (VF) test and Cirrus optical coherence tomographic scan. Contrast sensitivity was measured with the Pelli-Robson and the Spaeth-Richman Contrast Sensitivity (SPARCS) tests. Vision-related performance was assessed by the Compressed Assessment of Ability Related to Vision (CAARV) test. Vision-related QoL was assessed by the National Eye Institute Visual Function Questionnaire 25 (NEI-VFQ-25) and a modified Glaucoma Symptom Scale (MGSS). MAIN OUTCOMES AND MEASURES Correlations between clinical measures and CAARV, NEI-VFQ-25, and MGSS scores. RESULTS A total of 161 patients were enrolled in the study. The strongest correlation was found between SPARCS score in the better eye and total CAARV score (r = 0.398; 95% CI, 0.235-0.537; P < .001). The CAARV score also correlated with the Pelli-Robson score (r = 0.353; 95% CI, 0.186-0.499; P = .001), VF mean deviation (r = 0.366; 95% CI, 0.200-0.510; P < .001), and VA (r = -0.326, 95% CI = -0.476 to -0.157; P = .003) in the better eye. There were more statistically significant correlations between contrast sensitivity tests and VF mean deviation with VRQoL measurements than with other clinical measures (visual acuity, intraocular pressure, Disc Damage Likelihood Scale, and mean retinal nerve fiber layer thickness). The MGSS scores were lower (worse) in women compared with men (P = .03 for binocular, P = .01 for better eye, and P = .05 for the worse eye). Structural measures (eg, Disc Damage Likelihood Scale, and retinal nerve fiber layer thickness) were generally not informative with respect to VRP or VRQoL. CONCLUSIONS AND RELEVANCE Contrast sensitivity tests and VF mean deviation were associated with both objective measures of the ability to act and subjective measurements of VRQoL. The strongest correlation was between SPARCS score (contrast sensitivity) in the better eye and total CAARV score. Therefore, measurement of contrast sensitivity should be considered when evaluating patients' VRQoL. The results of this study were limited by the patient population and apply only within the bounds of the tested cohort.
Collapse
Affiliation(s)
- Feyzahan Ekici
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Rebecca Loh
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Michael Waisbourd
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Yi Sun
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Patricia Martinez
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Natasha Nayak
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Sheryl S Wizov
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Sarah Hegarty
- Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Lisa A Hark
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - George L Spaeth
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, Pennsylvania
| |
Collapse
|
21
|
Truong H, Hegarty S, Hubosky S, Healy K, Hoffman-Censits J, Giri V. PD13-07 CHARACTERIZATION OF UPPER TRACT UROTHELIAL CARCINOMA IN PATIENTS WITH CLINICAL SUSPICION OF LYNCH SYNDROME. J Urol 2016. [DOI: 10.1016/j.juro.2016.02.978] [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] [Indexed: 12/01/2022]
|
22
|
Abstract
126 Background: Comorbidities and treatment-related symptoms (sx) affect overall function and may impact return to work. We evaluated SF-12 physical and mental functioning in CRC working (W) and non-working (NW) survivors. Methods: 300 Stage I-III CRC survivors age 25-70 years identified by PA Cancer Registry who completed curative therapy 3-5 years prior to study and were employed at diagnosis were surveyed with validated measures via mail-survey procedures. Current work status (working/not working), demographics, and medical factors (diagnosis, treatment, comorbidities) were assessed, as was fatigue, insomnia, distress, cognitive sx, neuropathy, bowel sx, and urinary sx. Study approved by PA Department of Health; participants (pts) provided informed consent. Results: Pts average age 57 yrs (80% < 65 yrs), 56% male, 87% white, 67% educated beyond high school, 73% married. 56% had rectal cancer, 51% had chemotherapy, 39% had radiation therapy, 16% had an ostomy. Work status at survey: 226 pts (75%) W; 74 pts (25%) NW. Higher comorbidity number was associated with lower physical (PCS) component scores in both W and NW groups (p = 0.004 and 0.013), and with lower mental (MCS) component scores in the NW group (p = 0.004). Among W pts, predictors of lower PCS were fatigue (p = 0.001), bowel problems (p < 0.001), neuropathy (p = 0.009), and being male (p = 0.03). Predictors of lower MCS were fatigue (p = 0.003), cognitive issues (p < 0.001), and distress (p < 0.001). Among NW pts, predictors of lower PCS were fatigue (p = 0.02), neuropathy (p = 0.007), ostomy presence (p = 0.015), and being unmarried (p = 0.007). Predictors of lower MCS were distress (p < 0.001) and younger age (p = 0.007). Conclusions: Both W and NW CRC survivors have significant comorbidity and sx burden associated with poorer physical and mental functioning. Fatigue, neuropathy, and distress were predictors in both groups, while cognitive and bowel sx predicted poorer function among W survivors. Intervening on these modifiable sx may increase survivors’ return to work and improve functioning for those who do. Next steps will focus on intensive management of modifiable sx to determine the effect on physical and mental functioning and potential for returning to work after treatment.
Collapse
Affiliation(s)
| | - Sarah Hegarty
- Thomas Jefferson University Hospital, Philadelphia, PA
| | | | | | | |
Collapse
|
23
|
|
24
|
Tuazon SA, King GT, Sta. Cruz J, Chae YK, Ong Kian Koc JB, Hegarty S, Leighton JC. Angiotensin-converting enzyme inhibitor and angiotensin receptor blocker use and outcomes in patients with colorectal cancer. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.e14516] [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] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | - Young K. Chae
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Sarah Hegarty
- Thomas Jefferson University Hospital, Philadelphia, PA
| | | |
Collapse
|
25
|
Bruminhent J, Wang ZX, Hu C, Wagner J, Sunday R, Bobik B, Hegarty S, Keith S, Alpdogan S, Carabasi M, Filicko-O'Hara J, Flomenberg N, Kasner M, Outschoorn UM, Weiss M, Flomenberg P. Clostridium difficile colonization and disease in patients undergoing hematopoietic stem cell transplantation. Biol Blood Marrow Transplant 2014; 20:1329-34. [PMID: 24792871 DOI: 10.1016/j.bbmt.2014.04.026] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [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: 02/05/2014] [Accepted: 04/24/2014] [Indexed: 10/25/2022]
Abstract
There was an increase in the Clostridium difficile infection (CDI) rate in our bone marrow transplantation unit. To evaluate the role of unit-based transmission, C. difficile screening was performed on adult patients admitted for hematopoietic stem cell transplantation (HSCT) over a 2-year period, and C. difficile isolates were typed. C. difficile testing was performed using a 2-step C. difficile glutamate dehydrogenase antigen plus toxin A/B enzyme immunoassay (EIA) and cytotoxin assay (or molecular toxin assay). Multilocus sequence typing (MLST) was performed on toxin-positive whole stool samples. A retrospective chart review was performed on all patients with a positive toxin assay. Sixteen of 150 patients (10.7%) had toxigenic C. difficile colonization (CDC) on admission. The overall incidence of CDI within 100 days after HSCT was 24.7% (37 of 150). The median time to diagnosis of CDI was 3.5 days after HSCT. In an adjusted logistic regression model, CDC on admission was a significant risk factor for CDI (odds ratio, 68.5; 95% confidence interval, 11.4 to 416.2). MLST on 22 unit patient toxin-positive stool specimens revealed 15 distinct strain types. Further analysis identified at least 1 potential cross-transmission event; some events may have been missed because of incomplete typing from other specimens. Despite aggressive infection control interventions, there was no decline in the number of CDI cases during the study period. These data suggest that prior CDC plays a major role in CDI rates in this high-risk patient population. It remains unclear if CDI was cross-transmitted in the unit.
Collapse
Affiliation(s)
- Jackrapong Bruminhent
- Division of Infectious Diseases and Environmental Medicine, Department of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Zi-Xuan Wang
- Department of Pathology, Anatomy, and Cell Biology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Carol Hu
- Division of Infectious Diseases and Environmental Medicine, Department of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - John Wagner
- Department of Medical Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Richard Sunday
- Department of Pathology, Anatomy, and Cell Biology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Brent Bobik
- Department of Pathology, Anatomy, and Cell Biology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Sarah Hegarty
- Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Scott Keith
- Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Seyfettin Alpdogan
- Department of Medical Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Matthew Carabasi
- Department of Medical Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Joanne Filicko-O'Hara
- Department of Medical Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Neal Flomenberg
- Department of Medical Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Margaret Kasner
- Department of Medical Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | | | - Mark Weiss
- Department of Medical Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Phyllis Flomenberg
- Division of Infectious Diseases and Environmental Medicine, Department of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania.
| |
Collapse
|
26
|
Den RB, Kamrava M, Sheng Z, Werner-Wasik M, Dougherty E, Marinucchi M, Lawrence YR, Hegarty S, Hyslop T, Andrews DW, Glass J, Friedman DP, Green MR, Camphausen K, Dicker AP. A phase I study of the combination of sorafenib with temozolomide and radiation therapy for the treatment of primary and recurrent high-grade gliomas. Int J Radiat Oncol Biol Phys 2012; 85:321-8. [PMID: 22687197 DOI: 10.1016/j.ijrobp.2012.04.017] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Revised: 04/03/2012] [Accepted: 04/10/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE Despite recent advances in the management of high-grade and recurrent gliomas, survival remains poor. Antiangiogenic therapy has been shown to be efficacious in the treatment of high-grade gliomas both in preclinical models and in clinical trials. We sought to determine the safety and maximum tolerated dose of sorafenib when combined with both radiation and temozolomide in the primary setting or radiation alone in the recurrent setting. METHODS AND MATERIALS This was a preclinical study and an open-label phase I dose escalation trial. Multiple glioma cell lines were analyzed for viability after treatment with radiation, temozolomide, or sorafenib or combinations of them. For patients with primary disease, sorafenib was given concurrently with temozolomide (75 mg/m(2)) and 60 Gy radiation, for 30 days after completion of radiation. For patients with recurrent disease, sorafenib was combined with a hypofractionated course of radiation (35 Gy in 10 fractions). RESULTS Cell viability was significantly reduced with the combination of radiation, temozolomide, and sorafenib or radiation and sorafenib. Eighteen patients (11 in the primary cohort, 7 in the recurrent cohort) were enrolled onto this trial approved by the institutional review board. All patients completed the planned course of radiation therapy. The most common toxicities were hematologic, fatigue, and rash. There were 18 grade 3 or higher toxicities. The median overall survival was 18 months for the entire population. CONCLUSIONS Sorafenib can be safely combined with radiation and temozolomide in patients with high-grade glioma and with radiation alone in patients with recurrent glioma. The recommended phase II dose of sorafenib is 200 mg twice daily when combined with temozolomide and radiation and 400 mg with radiation alone. To our knowledge, this is the first publication of concurrent sorafenib with radiation monotherapy or combined with radiation and temozolomide.
Collapse
Affiliation(s)
- Robert B Den
- Department of Radiation Oncology, Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Yamoah K, Beecham K, Hegarty S, Hyslop T, Showalter TN, Yarney J. Early results of prostate cancer radiation therapy at Korle Bu Teaching Hospital: An analysis with emphasis on research strategies to improve treatment delivery and outcomes among patients in Ghana. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.e15163] [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: 11/20/2022] Open
Abstract
e15163 Background: Although there is interest in racial disparities in prostate cancer outcomes among persons of African descent living in the United States there is scant data available regarding disease presentation and treatment response among black men living in Africa. In this study we evaluate disease presentation and early clinical outcomes among Ghanaian men with prostate cancer treated with external beam radiotherapy (EBRT). Methods: A total of 379 men with prostate cancer were referred to the National Center for Radiotherapy and Nuclear Medicine, Ghana, from January 2003 to December 2009. Data were collected regarding patient- and tumor-related factors such as age, prostate specific antigen (PSA), Gleason score, clinical stage, and use of hormonal therapy. For patients who received EBRT, freedom from biochemical failure (FFbF) was evaluated using Kaplan-Meier analysis. Results: The median age at diagnosis was 65 years. Of 379 patients referred for treatment 69.6% of all patients had initial PSA >20ng/ml, and the median iPSA was 39.0 ng/ml. A total of 128 men representing 33.8% of overall cohort were diagnosed with metastatic disease at time of referral. We identified 166 men treated with EBRT or brachytherapy +/- androgen depravation therapy (ADT), and an additional 139 men treated with ADT alone (including orchiectomy in 38 patients). The median EBRT dose was 70 Gy, in 2 Gy per fraction. Among all EBRT patients with at least 2 years of follow-up after treatment (n=52; median follow-up time: 38.9 months), 5-year actuarial FFbF was 65.1%: 67.0% for patients with PSA < 30.0 ng/mL and 63.2% for PSA ≥ 30.0 ng/mL [log-rank, p=0.586]. Conclusions: This is the largest series reporting on outcomes for prostate cancer treatment in West Africa. That one-third of patients presented with metastatic disease suggests potential need for earlier detection of prostate cancer to permit curative-intent local therapy. Data from this study will aid in the strategic development of a prostate cancer research roadmap in Ghana, with a focus on improving therapeutic approach as well as fostering a prudent allocation of scarce resources.
Collapse
Affiliation(s)
- Kosj Yamoah
- Thomas Jefferson University Hospital, Philadelphia, PA
| | - Kwamena Beecham
- National Center for Radiotherapy and Nuclear Medicine, Accra, Ghana
| | - Sarah Hegarty
- Thomas Jefferson University Hospital, Philadelphia, PA
| | - Terry Hyslop
- Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA
| | - Timothy Norman Showalter
- Department of Radiation Oncology, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Joel Yarney
- National Center for Radiotherapy and Nuclear Medicine, Accra, Ghana
| |
Collapse
|
28
|
Shen X, Zaorsky NG, Mishra MV, Foley KA, Hyslop T, Hegarty S, Pizzi LT, Dicker AP, Showalter TN. Comparative effectiveness research for prostate cancer radiation therapy: current status and future directions. Future Oncol 2012; 8:37-54. [PMID: 22149034 DOI: 10.2217/fon.11.131] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Comparative effectiveness research aims to help clinicians, patients and policymakers make informed treatment decisions under real-world conditions. Prostate cancer patients have multiple treatment options, including active surveillance, androgen deprivation therapy, surgery and multiple modalities of radiation therapy. Technological innovations in radiation therapy for prostate cancer have been rapidly adopted into clinical practice despite relatively limited evidence for effectiveness showing the benefit for one modality over another. Comparative effectiveness research has become an essential component of prostate cancer research to help define the benefits, risks and effectiveness of the different radiation therapy modalities currently in use for prostate cancer treatment.
Collapse
Affiliation(s)
- Xinglei Shen
- Department of Radiation Oncology, Kimmel Cancer Center & Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Ford AH, Flicker L, McCaul K, van Bockxmeer F, Hegarty S, Hirani V, Fenner S, Almeida OP. Erratum to: The B-VITAGE trial: A randomized trial of homocysteine lowering treatment of depression in later life. Trials 2011. [PMCID: PMC3170608 DOI: 10.1186/1745-6215-12-193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
30
|
Gremel G, Ryan D, Rafferty M, Lanigan F, Hegarty S, Lavelle M, Murphy I, Unwin L, Joyce C, Faller W, McDermott EW, Sheahan K, Ponten F, Gallagher WM. Functional and prognostic relevance of the homeobox protein MSX2 in malignant melanoma. Br J Cancer 2011; 105:565-74. [PMID: 21730974 PMCID: PMC3170959 DOI: 10.1038/bjc.2011.249] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Background: The homeobox containing transcription factor MSX2 is a key regulator of embryonic development and has been implicated to have a role in breast and pancreatic cancer. Methods: Using a selection of two- and three-dimensional in vitro assays and tissue microarrays (TMAs), the clinical and functional relevance of MSX2 in malignant melanoma was explored. A doxycyline-inducible over-expression system was applied to study the relevance of MSX2 in vitro. For TMA construction, tumour material from 218 melanoma patients was used. Results: Ectopic expression of MSX2 resulted in the induction of apoptosis and reduced the invasive capacity of melanoma cells in three-dimensional culture. MSX2 over-expression was shown to affect several signalling pathways associated with cell invasion and survival. Downregulation of N-Cadherin, induction of p21 and inhibition of both BCL2 and Survivin were observed. Cytoplasmic MSX2 expression was found to correlate significantly with increased recurrence-free survival (P=0.008). Nuclear expression of MSX2 did not result in significant survival correlations, suggesting that the beneficial effect of MSX2 may be independent of its DNA binding activity. Conclusions: MSX2 may be an important regulator of melanoma cell invasion and survival. Cytoplasmic expression of the protein was identified as biomarker for good prognosis in malignant melanoma patients.
Collapse
Affiliation(s)
- G Gremel
- UCD School of Biomolecular and Biomedical Science, UCD Conway Institute, University College Dublin, Belfield, Dublin 4, Ireland
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Ford AH, Flicker L, McCaul K, van Bockxmeer F, Hegarty S, Hirani V, Fenner S, Almeida OP. The B-VITAGE trial: a randomized trial of homocysteine lowering treatment of depression in later life. Trials 2010; 11:8. [PMID: 20096138 PMCID: PMC2822769 DOI: 10.1186/1745-6215-11-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2009] [Accepted: 01/25/2010] [Indexed: 12/28/2022] Open
Abstract
Background Depression is a leading cause of disability worldwide and depressive symptoms are common in later life. Observational evidence suggests that depression is more prevalent among people with high plasma homocysteine (tHcy), but the results of randomized trials to date have been unable to show that lowering tHcy through the supplementation of vitamins B6, B12 and folate benefits depressive symptoms. We designed the B-VITAGE trial to determine whether adjunctive treatment with vitamins B6, B12 and folate increases the efficacy of standard antidepressant treatment. Methods/Design The B-VITAGE trial is a 12-month randomized, double-blind, placebo-controlled trial of daily citalopram (20 to 40 mg) plus B12(0.4 mg), B6 (25 mg) and folic acid (2 mg) or citalopram (20 to 40 mg) plus placebo for the treatment of depression in later life. The trial aims to recruit over 300 older adults with major depression (DSM-IV) and has been powered to detect the impact of an intervention associated with moderate effect size. Depressive symptoms will be rated with the Montgomery-Åsberg Depression Rating Scale (MADRS). The trial has two main outcomes of interest: a reduction of 50% or more in the MADRS total score between baseline and week 12 and the remission of the depressive episode at weeks 12, 26 and 52 according to DSM-IV criteria. We hypothesize that subjects randomly allocated to the vitamin arm of the study will be more likely to show a clinically significant improvement and achieve and maintain remission of symptoms at 12, 26 and 52 weeks. Secondary outcomes of interest include compliance with treatment, reduction in the severity of depressive symptoms, switching to different antidepressants, the use of non-pharmacological antidepressant treatments, response to treatment according to MTHFRC677T genotype, and changes in cognitive function over 52 weeks. Conclusions The results of this trial will clarify whether the systematic use of B-vitamins improves the response of older adults to standard antidepressant treatment. We anticipate that our findings will have implications for clinical practice and health policy development. Trial Registration The trial is registered with the Australian Clinical Trials Registry, trial number (())ACTRN12609000256279.
Collapse
Affiliation(s)
- Andrew H Ford
- Western Australian Centre for Health & Ageing, Centre for Medical Research, University of Western Australia, Perth, Australia
| | | | | | | | | | | | | | | |
Collapse
|
32
|
Leyden J, O'Shea C, Hegarty S, Macmathuna P. An unusual finding in a patient with iron deficiency anaemia. Gut 2005; 54:1491, 1499. [PMID: 16162954 PMCID: PMC1774709 DOI: 10.1136/gut.2005.067082] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Affiliation(s)
- J Leyden
- Gastrointestinal Unit, Mater Misericordiae University Hospital, University College Dublin, Ireland
| | | | | | | |
Collapse
|
33
|
Lunn JV, Gallagher PM, Hegarty S, Kaliszer M, Crowe J, Murray P, Bouchier-Hayes D. The role of hereditary hemochromatosis in aseptic loosening following primary total hip arthroplasty. J Orthop Res 2005; 23:542-8. [PMID: 15885473 DOI: 10.1016/j.orthres.2004.11.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2004] [Revised: 08/27/2004] [Accepted: 11/02/2004] [Indexed: 02/04/2023]
Abstract
Hereditary hemochromatosis (HH) results in increased iron absorption and subsequent deposition in tissue. This condition occurs predominantly in individuals of Northern European and Celtic origin with Ireland having one of the highest allele frequencies in the world. This study examines the hypothesis that homozygosity for either the C282Y or H63D mutations in the HFE gene may be associated with aseptic loosening following total hip arthroplasty (THA). Two groups of individuals were screened for the C282Y and H63D mutations associated with HH. Group 1 were individuals who had undergone primary hip arthroplasty and group 2 were individuals who had undergone revision hip arthroplasty for aseptic loosening. Exclusion criteria included rheumatoid or other inflammatory arthropathies and revision due to causes other than aseptic loosening. Significantly more patients in the revision THA group were homozygous for the C282Y genotype (P = 0.014). Aseptic loosening occurred earlier in these patients (P = 0.009), in particular in the patients who had clinical signs of hemochromatosis. No association was seen with the H63D mutation and revision THA. The incidence of HH in the group of primary THA patients was no higher than the background incidence. Patients who require primary THA and who are homozygous for the C282Y mutation have an increased risk of developing aseptic loosening, leading to revision THA. Moreover C282Y homozygosity appears to be associated with earlier aseptic loosening than in individuals without the C282Y mutation.
Collapse
Affiliation(s)
- J V Lunn
- FRCSI, SpR Orthopaedics, Cappagh National Orthopaedic Hospital, Dublin, Ireland.
| | | | | | | | | | | | | |
Collapse
|
34
|
Skinner LJ, Conlon BJ, Hegarty S, O'Dwyer TP. Ectopic ossification in the parotid gland. Rev Laryngol Otol Rhinol (Bord) 2003; 124:243-5. [PMID: 15038567] [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] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
We present a unique report of ectopic ossification with dystrophic calcification within an otherwise histologically normal parotid gland. The histopathological features of the case are discussed and general pathogenetic explanations for the lesion are explored.
Collapse
Affiliation(s)
- L J Skinner
- Mater Misericordiae Hospital, Department of Otolaryngology/Head and Neck Surgery, Dublin 7, Ireland.
| | | | | | | |
Collapse
|
35
|
Clarke G, Ryan E, O’Keane JC, Crowe J, McMathuna P, Moriarty D, Ettarh R, Sheahan K, Hyland J, O’Donoghue DP, Baird AW, Clarke G, Ryan E, Gormley G, Keane JCO, Crowe J, MacMathuna P, Wang JH, Wu QD, Redmond HP, Condron C, Bouchier-Hayes D, Nally K, Newton F, O’Connell J, O’Sullivan GC, Morgan J, Collins JK, Shanahan F, Goode C, O’Connell J, O’Sullivan GC, Collins JK, Shanahan F, Winter DC, Taylor CT, Skelly MM, O’Donoghue DP, O’Sullivan GC, Baird AW, Harvey BJ, Varghese JC, Farrell MA, McGrath FP, Murray FE, Osborne H, Lee MJ, Ryan E, Sullivan A, O’Keane JC, Crowe J, Ryan AE, O’Keane JC, Crowe J, Donovan AN, McCormick PA, Kenny B, Somers S, Bohan A, Gibney RG, Marcaccio M, Malone DE, Doyle M, Delaney CP, Gorey TF, McEntee GP, O’Sullivan GC, Clarke A, Stuart R, Kelly J, Kiely MD, Collins JK, Shanahan F, O’Sullivan M, Lovett E, Mahmud N, Kelleher D, O’Morain CA, Larkin CJ, Watson RGP, Sloan JM, Ardill JES, Johnston CF, Buchanan KD, Heaney A, Collins JSA, Watson GRP, Kalin RM, Heaney A, Collins JSA, Tham TCK, Watson RGP, McFarland RJ, Bamford KB, Cróinín TÓ, Clyne M, Drumm B, Rowland M, Kumar D, O’Connor P, Daly LE, Drumm B, O’Toole DL, Long A, Murphy AM, O’Neill L, Weir DG, Kelleher D, Heaney A, Collins JSA, Watson RGP, Hopkins AM, Moynagh P, O’Donoghue DP, Baird AW, Brennan C, Harmey J, Stapleton PP, Redmond HP, Bouchier-Hayes D, Rasheed AM, Chen G, Kelly C, Bouchier-Hayes DJ, Leahy A, Gallagher M, Grace A, Xin Y, Leader M, Kay E, Whelan A, Pattison U, Willoughby R, Wallace E, Weir D, Feighery C, Bennett MW, O’Connell J, O’Sullivan GC, Brady C, Roche D, Collins JK, Shanahan F, Mahmud N, Molloy A, McPartlin J, Scott JM, Weir DG, Acheson AG, Lee J, Khosraviani K, Irwin ST, McDaid J, McCormick PA, Docherty JR, O’Grady A, Kay E, Mabruk M, Grace A, Leader M, Lee J, Acheson AG, Irwin ST, Larkin CJ, Johnston C, Curry W, Ardill J, Cunningham R, Buchanan KD, Watson RGP, McDougall NI, Coyle PV, Callender ME, Ouinn AM, Warner R, Stevens FM, Chakravarthi PIS, Kearns M, Bourke M, Hassan A, McWeeney J, Stevens FM, McCarthy CF, Casey M, O’Donoghue J, Eustace-Ryan AM, O’Regan P, Feighery L, Jackson J, Cronin N, Shanahan F, Quane K, Feighery C, Mulligan ED, Purcell T, Dunne B, Griffin M, Noonan N, Hollywood D, Keeling N, Reynolds JV, Hennessy TPJ, Mulligan ED, Purcell T, Dunne B, Griffin M, Noonan N, Hollywood D, Keeling N, Reynolds JV, Hennessy TPJ, Mulligan ED, Purcell T, Dunne B, Griffin M, Noonan N, Hollywood D, Keeling N, Reynolds JV, Hennessy TPJ, Mulligan ED, Purcell T, Dunne B, Griffin M, Noonan N, Hollywood D, Keeling N, Reynolds JV, Hennessy TPJ, O’Sulhvan M, Harman I, Breslin NP, Clayton N, O’Morain CA, Hogan S, Donovan B, Hayes D, Kiely M, Eustace-Ryan AM, O’Regan P, Goulding CA, Albloushi SS, O’Connor J, Courtney MG, Murray FE, Albloushi SS, Goulding CA, Kay E, Royston D, Leader M, Courtney MG, Murray FE, Albloushi SS, Kay E, Goulding CA, Grace A, O’Connor J, Shattock AG, Courtney MG, Murray FE, Albloushi SS, Stack A, Kay E, Goulding CA, Carmody M, Murray FE, Courtney MG, Barrett S, Ryan E, O’Keane JC, Crowe J, Hennigan A, Delaney CP, Young L, Shields CJ, O’Keane C, Gorey TF, Fitzpatrick JM, Rasheed AM, Wang JH, Kelly C, Bouchier-Hayes DJ, Leahy A, Doyle MM, Stephens RB, Daly PA, Bennett MW, O’Connell J, O’Sullivan GC, Brady C, Roche D, Collins JK, Shanahan F, Briggs GM, McCrory D, Briggs GM, McCrory D, O’Neill S, O’Grady H, Grant DC, Barry K, Traynor O, Hyland JMP, O’Toole GC, Grant DC, Barry MK, Hyland JMP, Johnston SD, Ritchie CM, Robinson TJ, Johnston SD, Kirby JM, Mackle EM, Robinson TJ, Haider N, Aherne N, McNichol F, Hamilton D, Neary P, Hegarty S, Connor JO, Watson RGK, Drudy D, Alwan A, Fenelon L, O’Farrelly C, Hyland J, Byrne B, Madrigal L, Carton J, Collins C, O’Donoghue D, O’Farrelly C, Gannon N, Hickey A, O’Boyle CA, Byrne R, Albloushi S, Murray F. Irish society of gastroenterology. Ir J Med Sci 1998. [DOI: 10.1007/bf02937896] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
36
|
Bradley J, Hegarty S. Sixteen-and what next? Spec Educ Forward Trends 1982; 9:9-12. [PMID: 6215724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
|
37
|
Hegarty S. The growth of special centres. Spec Educ Forward Trends 1982; 9:27-9. [PMID: 6461077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
|
38
|
Hegarty S. Integration--some questions to ask. Spec Educ Forward Trends 1980; 7:8-10. [PMID: 7455787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
|