Objective
Little is known about long-term cognitive side effects of adjuvant chemotherapy for breast cancer. We thus examined incidence of dementia diagnoses in older women diagnosed with breast ...cancer, stratified by types of chemotherapy regimen.
Methods
We identified patients with incident dementia diagnoses through Medicare claims linked to the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) tumor registry data. The study population (
n
= 6,932) consisted of women at least 68 years of age, who were diagnosed with early-stage breast cancer from 1994 through 2002 in one of the SEER areas and received chemotherapy as part of their cancer treatment. Excluded were women with a diagnosis of dementia within the 3 years prior to their cancer diagnosis.
Results
Our sample comprised mostly white women. The mean age was 74. Fifty-seven percent were estrogen receptor positive. Over 70% had no comorbidity. The use of taxol and anthracycline-based treatments increased from mid-1990s to early 2000. Increasing age at cancer diagnosis, Black ethnicity, living in a census tract with lower level of education, and increasing number of comorbidities were associated with new claims of dementia diagnoses after chemotherapy. There was no significant association between types of chemotherapy agents and risk of subsequent dementia diagnoses.
Conclusion
No association was found between types of adjuvant chemotherapy agents for breast cancer and risk of new dementia diagnoses. Our findings suggest that concerns about post-chemotherapy dementia should not be a major factor in determining type of adjuvant chemotherapy regimen to prescribe for older women with breast cancer.
A timely response to patient-initiated telephone calls can affect many aspects of patient health, including quality of care and health equity. Historically, at a family medicine residency clinic, at ...least 1 out of 4 patient calls remained unresolved three days after the call was placed. We sought to explore whether there were differential delays in resolution of patient concerns for certain groups and how these were affected by quality improvement interventions to increase responsiveness to patient calls. A multidisciplinary team at a primary care residency clinic applied Lean education and tools to improve the timeliness of addressing telephone encounters. Telephone encounter data were obtained for one year before and nine months after the intervention. Data were stratified by race, ethnicity, preferred language, sex, online portal activation status, age category, zip code, patient risk category, and reason for call. Stratified data revealed consistently worse performance on telephone encounter closure by 72 hours for Black/African American patients compared to Hispanic and non-Hispanic White patients pre-intervention. Interventions resulted in statistically significant overall improvement, with an OR of 2.9 (95% CI: 2.62 to 3.21). Though interventions did not target a specific population, pre-intervention differences based on race and ethnicity resolved post-intervention. Telephone calls serve as an important means of patient communication with care teams. General interventions to improve the timeliness of addressing telephone encounters can lead to sustainable improvement in a primary care academic clinic and may also alleviate disparities.
BACKGROUND
Assessing trends in breast cancer survival among young women who are largely unaffected by breast cancer screening will provide important information regarding improvements in the ...effectiveness of cancer care for breast cancer in the last few decades.
METHODS
The cohort for this study consisted of women who were diagnosed with breast cancer between ages 20 and 39 years from the Surveillance, Epidemiology, and End Results program's 9‐registry areas from 1975 to 2015. Trends in the breast cancer incidence rate and survival were assessed among young women.
RESULTS
Among women aged 20 to 39 years, breast cancer incidence increased from 24.6 per 100,000 in 1975 to 31.7 per 100,000 in 2015 (annual percent change, 0.5; 95% confidence interval CI, 0.4‐0.6). Among women with breast cancer, 5‐year breast‐cancer‐specific survival increased significantly from 74.0% during 1975 to 1979 to 88.5% during 2010 to 2015 (hazard ratio for dying from breast cancer for 2010‐2015 vs 1975‐1979, 0.37; 95% CI, 0.32‐0.41). The increase in cancer‐specific survival reached a plateau in 2005; however, among young women with metastatic breast cancer, it continued to increase after 2005, from 45.6% during 2005 to 2009 to 56.5% during 2010 to 2015 (hazard ratio for dying from breast cancer for 2010‐2015 vs 2005‐2009, 0.74; 95% CI, 0.60‐0.92). Similar patterns also were observed for 5‐year overall survival and among women aged 20 to 29 years and those aged 30 to 39 years.
CONCLUSIONS
There were substantial improvements in the effectiveness of breast cancer treatment on overall and cancer‐specific survival from 1975 to 2015. However, improvements appeared to have reached a plateau after 2005, except among young women with metastatic breast cancer, in whom survival continued to improve throughout the period.
Data for the period from 1975 to 2015 in the Surveillance, Epidemiology, and End Results registry indicate that survival has improved significantly for young women (aged 20 to 39 years) with breast cancer in the last 4 decades, although the improvement recently has plateaued, except among young women with metastatic cancer, whose survival continued to improve throughout the period. This improved survival is most likely attributed to advances in cancer care, because these populations typically are not screened.
Mexican American men living in the United States who are more acculturated exhibit higher rates of cancer compared to those less acculturated. This study explored the association between ...acculturation and serum levels of nutrients thought to be involved with cancer prevention among Mexican American men.
Our sample included 2,479 Mexican American men from the Third National Health and Nutrition Examination Survey (1988-1994). Outcomes were serum levels of micronutrients. Acculturation in Mexican American men was assessed by a combined measure including country of origin, language of interview, and years of residence in the United States and was categorized as follows: (1) foreign-born, 0-5 years in the United States (lowest acculturation), (2) foreign-born, 6-15 years in the United States, (3) foreign-born, > 15 years in the United States, (4) US-born Spanish-speaking, and (5) US-born English-speaking (highest acculturation).
Adjusted analyses showed that acculturation decreased the serum levels for vitamin E, vitamin C, and folate and also for some carotenoids (alpha and beta carotenes, beta cryptoxanthin, and lutein-zeaxanthin). By contrast, acculturation increased the serum levels for selenium and lycopene.
With the exception of selenium and lycopene, acculturation among Mexican American men decreased the serum levels for most carotenoids and for vitamin E, vitamin C, and folate. These changes in nutrient profiles, reflecting altered patterns in food consumption or other behaviors, may explain in part why Mexican American men who are more acculturated have an increased risk for diet-related cancer
Aim
To identify the rate and risk factors of physical restraint in residential aged care facilities in Taiwan.
Background
In Taiwan, physical restraint is commonly used in aged care facilities to ...prevent accidents. Many are unaware of the associated risks. Restrained residents cannot move freely, increasing the risk of atrophy and leading to reduced physical functioning.
Design
A community‐based epidemiological survey.
Methods
Data were collected from June–December 2007 across 178 residential aged care facilities with 5,173 residential beds in the target city of Taiwan. Twenty facilities were sampled using probability proportional to size by beds and accreditation ranking. In all, 256 primary caregivers (78 nurses and 178 care aides) and 847 residents completed the study questionnaires and tests. A multilevel analysis approach was used to identify individual‐ and facility‐level risk factors for physical restraint and assess the variation in physical restraint at the individual‐ and facility‐level.
Results
Of 847 residents, 62% (527) were restrained during the study period. The main reasons for restraint use were fall prevention and prevention of tube removal. Resident level risk factors for physical restraint included lower Barthel Index scores (more dependent) and an agreement allowing the use of physical restraint to avoid injury signed by a family member or social worker. A facility‐level risk factor for physical restraint was younger primary caregivers.
Conclusion
To reduce the incidence of physical restraint in residential aged care facilities in Taiwan, educational programmes should target primary caregivers and families in facilities.
PDF
