Background
Chemoradiation with curative intent in older adults with locally advanced head and neck squamous cell carcinoma (HNSCC) has been a challenge, because of its potential toxicities.
Methods
...We selected primary HNSCC cases from the SEER‐Medicare linked database, assessed overall survival (OS) and adverse events and their associations with different treatments, across four age groups including the youngest (66–69 years) and the oldest (≥80 years).
Results
Better OS was associated with chemoradiation compared to radiation alone, not only in all patients (N = 5879) (hazard ratio HR = 0.82, p < 0.001), but also in the oldest group (N = 1380) (HR = 0.77, p = 0.006) in whom the adverse events rates were not higher than those in the youngest (N = 1562); more of the latter (26%–30%) than the former (14%–19%) received chemoradiation, regardless of their comorbidity indices.
Conclusions
Our findings provide evidence that patients' characteristics, other than chronological age, should be equally considered in selecting the best therapy for older patients with HNSCC.
Background
The best chemoradiation regimen to treat locally and regionally advanced head and neck squamous cell carcinoma (HNSCC) is yet to be established.
Methods
We compared overall survival (OS) ...and adverse events following chemoradiation regimens (high‐dose HDC or low‐dose LDC cisplatin, or carboplatin CB) in HNSCC cases selected from SEER‐Medicare linked database.
Results
Of the 1335 cases who underwent radiotherapy, 264 received HDC, 259 received LDC, and 353 received CB, concurrently. Compared to chemoradiation with HDC, using LDC or CB, or radiotherapy alone were associated with an increasingly worse OS; hazard ratios were 1.33, p = 0.03; 1.35, p = 0.02; and 2.12, p < 0.001; respectively. There were no differences in the rates of adverse events between the three chemoradiation regimens.
Conclusion
Chemoradiation regimen using HDC appears to be the best primary treatment for locally and regionally advanced HNSCC. Nonetheless, prospective large studies are warranted to further determine its absolute benefit.
Myotonic dystrophy type I (DM1) is an autosomal dominant multisystem disorder characterized by myotonia and muscle weakness. Type 2 diabetes (T2D) and cancer have been shown to be part of the DM1 ...phenotype. Metformin, a well‐established agent for the management of T2D, is thought to have cancer‐preventive effects in the general population. In our study, we aimed to assess the association between T2D, metformin use and the risk of cancer in DM1 patients. We identified a cohort of 913 DM1 patients and an age‐, sex‐ and clinic‐matched cohort of 12,318 DM1‐free controls from the UK Clinical Practice Research Datalink, a large primary care records database. We used Cox regression models to assess cancer risk in T2D patients who were metformin users or nonusers compared to patients without T2D. Separate analyses were conducted for DM1 patients and controls. T2D was more prevalent in DM1 than in controls (8% vs. 3%, p < 0.0001). DM1 patients with T2D, compared to those without T2D, were more likely to develop cancer (hazard ratio HR = 3.60, 95% confidence interval CI = 1.18–10.97; p = 0.02), but not if they were treated with metformin (HR = 0.43, 95% CI = 0.06–3.35; p = 0.42). Among controls, we observed no significant associations between T2D and cancer risk in either users or nonusers of Metformin (HR = 1.28, 95% CI = 0.91–1.79; p = 0.16 and HR = 1.13, 95% CI = 0.72–1.79; p = 0.59, respectively). These results show an association between T2D and cancer risk in DM1 patients and may provide new insights into the possible benefits of Metformin use in DM1.
What's new?
Recent evidence suggests that myotonic dystrophy type I (DM1), an inherited nucleotide repeat disorder, is a cancer predisposition syndrome. However, the underlying pathological mechanisms and cancer‐predisposing risk factors remain unknown. Here, type 2 diabetes (T2D) and metformin were investigated for potential associations with cancer risk in DM1 patients. T2D was found to be more prevalent in DM1 patients than controls. DM1 patients with T2D were at increased risk of developing cancer. By contrast, cancer risk was not elevated in DM1‐T2D patients taking metformin. Further investigation of metformin use and cancer in DM1 patients could yield important insights into DM1‐related cancer prevention.
Purpose
Investigators have reported inconsistent findings regarding associations between body mass index (BMI) and bladder cancer risk, and they have postulated that sex steroids mediate such ...associations. We assessed the impact of BMI on the relationship between bladder cancer risk and combinations of age at first childbirth, parity, and age at menopause, among Egyptian women.
Methods
We used data from our multicenter case–control study of 419 cases and 786 controls in logistic regression models to estimate adjusted odds ratios (AORs) and 95% confidence intervals (CIs) of such associations.
Results
Age > 18 years at first childbirth and parity ≤ 6 were significantly associated with bladder cancer risk, which was higher when both factors (AOR = 2.31, 95% CI = 1.55–3.43) and age at menopause < 45 years (AOR = 3.51, 95% CI = 1.88–6.55) were present. Early menopause was associated with higher bladder cancer risk in obese (AOR = 2.90, 95% CI = 1.40–5.98) but not normal weight women (AOR = 0.98, 95% CI = 0.58–1.65;
P
interaction
= 0.11), and the risk was greatest when both first childbirth at age > 18 years and parity ≤ 6 were present (AOR = 7.60, 95% CI = 1.84–31.35); however, overweight and obesity were associated with significantly lower bladder cancer risk (AOR = 0.59, 95% CI = 0.43–0.81, and AOR = 0.26, 95% CI = 0.18–0.38, respectively).
Conclusion
Body mass index appears to modify bladder cancer risk in Egyptian women after menopause by slightly enhancing the risk associated with low estrogen exposure among the obese only. Longitudinal studies of the BMI role in bladder malignancy in this distinctive population are required.
ABSTRACT
Frequent manual repositioning is an established part of pressure ulcer prevention, but there is little evidence for its effectiveness. This study examined the association between ...repositioning and pressure ulcer incidence among bed‐bound elderly hip fracture patients, using data from a 2004–2007 cohort study in nine Maryland and Pennsylvania hospitals. Eligible patients (n=269) were age ≥65 years, underwent hip fracture surgery, and were bed‐bound at index study visits (during the first 5 days of hospitalization). Information about repositioning on the days of index visits was collected from patient charts; study nurses assessed presence of stage 2+ pressure ulcers 2 days later. The association between frequent manual repositioning and pressure ulcer incidence was estimated, adjusting for pressure ulcer risk factors using generalized estimating equations and weighted estimating equations. Patients were frequently repositioned (at least every 2 hours) on only 53% (187/354) of index visit days. New pressure ulcers developed at 12% of visits following frequent repositioning vs. 10% following less frequent repositioning; the incidence rate of pressure ulcers per person‐day did not differ between the two groups (incidence rate ratio 1.1, 95% confidence interval 0.5–2.4). No association was found between frequent repositioning of bed‐bound patients and lower pressure ulcer incidence, calling into question the allocation of resources for repositioning.
We investigated associations between tobacco exposure, history of schistosomiasis, and bladder cancer risk in Egypt.
We analyzed data from a case-control study (1,886 newly diagnosed and ...histologically confirmed cases and 2,716 age-, gender-, and residence-matched, population-based controls). Using logistic regression, we estimated the covariate-adjusted ORs and 95% confidence interval (CI) of the associations.
Among men, cigarette smoking was associated with an increased risk of urothelial carcinoma (OR = 1.8; 95% CI, 1.4-2.2) but not squamous cell carcinoma (SCC); smoking both water pipes and cigarettes was associated with an even greater risk for urothelial carcinoma (OR = 2.9; 95% CI, 2.1-3.9) and a statistically significant risk for SCC (OR = 1.8; 95% CI, 1.2-2.6). Among nonsmoking men and women, environmental tobacco smoke exposure was associated with an increased risk of urothelial carcinoma. History of schistosomiasis was associated with increased risk of both urothelial carcinoma (OR = 1.9; 95% CI, 1.2-2.9) and SCC (OR = 1.9; 95% CI, 1.2-3.0) in women and to a lesser extent (OR = 1.4; 95% CI, 1.2-1.7 and OR = 1.4; 95% CI, 1.1-1.7, for urothelial carcinoma and SCC, respectively) in men.
The results suggest that schistosomiasis and tobacco smoking increase the risk of both SCC and urothelial carcinoma.
This study provides new evidence for associations between bladder cancer subtypes and schistosomiasis and suggests that smoking both cigarettes and water pipes increases the risk for SCC and urothelial carcinoma in Egyptian men.
The University of Maryland Department of Epidemiology and Public Health collaborated with the Center for Integrative Medicine at the same institution to develop and implement a unique integrative ...medicine curriculum within a preventive medicine residency program. Between October 2012 and July 2014, Center for Integrative Medicine faculty provided preventive medicine residents and faculty, and occasionally other Department of Epidemiology and Public Health faculty, with comprehensive exposure to the field of integrative medicine, including topics such as mind–body medicine, nutrition and nutritional supplements, Traditional Chinese Medicine, massage, biofield therapies, manual medicine, stress management, creative arts, and the use of integrative medicine in the inpatient setting. Preventive medicine residents, under the supervision of Department of Epidemiology and Public Health faculty, led integrative medicine–themed journal clubs. Resident assessments included a case-based knowledge evaluation, the Integrative Medicine Attitudes Questionnaire, and a qualitative evaluation of the program. Residents received more than 60 hours of integrative medicine instruction, including didactic sessions, experiential workshops, and wellness retreats in addition to clinical experiences and individual wellness mentoring. Residents rated the program positively and recommended that integrative medicine be included in preventive medicine residency curricula. The inclusion of a wellness-focused didactic, experiential, and skill-based integrative medicine program within a preventive medicine residency was feasible and well received by all six preventive medicine residents.
Egypt has the world's highest prevalence of infection with hepatitis C virus (HCV), which is a major cause of hepatocellular carcinoma. The high HCV prevalence is largely attributed to the parenteral ...antischistosomal therapy (PAT) campaigns conducted from the 1950s through the 1980s; however, the primary modes of transmission in the post-PAT period are not well known. In this study we examined the associations between HCV prevalence and exposures to risk factors, including PAT, in a high HCV prevalence population.
Using a cross-sectional design, we examined the associations between demographic characteristics and risk factors for HCV transmission and HCV positivity prevalence among a sample of Egyptian residents. Data were collected through an interview-administered survey, and the association estimates were determined using χ (2) and logistic regression.
The highest HCV positivity prevalence was observed in cohorts born before 1960, and declined precipitously thereafter; whereas the proportion of subjects reporting PAT remained relatively stable. Being male, having a rural residence, and having received PAT were all associated with HCV positivity; however, PAT alone could not account for the high prevalence of HCV.
In Egypt, PAT and other transmission factors yet to be identified, as well as cohorts born before the 1960s and infected with HCV, are most likely the main contributors to the current HCV endemic.
Integrative Medicine in Preventive Medicine Education Burton, Dee, PhD; Trask, Jennifer, PharmD, ND; Sandvold, Irene, DrPH ...
American journal of preventive medicine,
November 2015, Letnik:
49, Številka:
5
Journal Article
Recenzirano
Odprti dostop
In September 2012, the Health Resources and Services Administration funded 12 preventive medicine residency programs to participate in a 2-year project aimed at incorporating integrative medicine ...(IM) into their residency training programs. The grantees were asked to incorporate competencies for IM into their respective preventive medicine residency curricula and to provide for faculty development in IM. The analysis conducted in 2014–2015 used the following evidence to assess residency programs’ achievements and challenges in implementation: progress and performance measures reports, curriculum mapping of program activities to IM competencies, records of webinar participation, and post-project individual semi-structured phone interviews with the 12 grantee project leaders. Key findings are: (1) IM activities offered to residents increased by 50% during the 2 years; (2) Accessing IM resources already in existence at local grantee sites was the primary facilitator of moving the integration of IM into preventive medicine residencies forward; (3) Among all activities offered residents, rotations were perceived by grantees as by far the most valuable contributor to acquiring IM competencies; (4) Online training was considered a greater contributor to preventive medicine residents’ medical knowledge in IM than faculty lectures or courses; (5) Faculty were offered a rich variety of opportunities for professional development in IM, but some programs lacked a system to ensure faculty participation; and (6) Perceived lack of evidence for IM was a barrier to full program implementation at some sites. Grantees expect implemented programs to continue post-funding, but with decreased intensity owing to perceived faculty and curriculum time constraints.
Abstract
Background
Myotonic dystrophy type 1 (DM1) is an inherited trinucleotide repeat disorder in which specific cancers have been implicated as part of the disease phenotype. This study aimed to ...assess whether cancer risk in DM1 patients is modified by disease severity.
Methods
Using the United Kingdom Clinical Practice Research Datalink (primary care electronic medical records), we identified a cohort of 927 DM1 and a matched cohort of 13 085 DM1-free individuals between January 1, 1988 and February 29, 2016. We used Cox regression models to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs) of organ-specific cancer risks. Analyses were stratified by age at DM1 diagnosis as a surrogate for disease severity. Statistical tests were two-sided.
Results
Patients with classic DM1 (age at diagnosis: 11–40 years) were at elevated risk of cancer overall (HR = 1.81; 95% CI = 1.12 to 2.93); cancers of the thyroid (HR = 15.93; 95% CI = 2.45 to 103.64), uterus (HR = 26.76; 95% CI = 2.32 to 309.26), and cutaneous melanoma (HR = 5.98; 95% CI = 1.24 to 28.79) accounted for the excess. In late-onset DM1 patients (age at diagnosis >40 years), a reduced overall cancer risk was observed (HR = 0.53; 95% CI = 0.32 to 0.85), possibly driven by the deficit in hematological malignancies (DM1 = 0 cases, DM1-free = 54 cases; P = .02). The difference between the observed HR for classic and late-onset DM1 was statistically significant (P < .001).
Conclusions
The observed difference in relative cancer risk between classic and late-onset DM1 patients compared with their DM1-free counterparts provides the first evidence that disease severity modifies DM1-related cancer susceptibility. This novel finding may guide clinical management and scientific investigations for the underlying molecular mechanisms in DM-related carcinogenesis.
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