There is limited available information on patterns of utilization and efficacy of alternative medicine (AM) for patients with cancer. We identified 281 patients with nonmetastatic breast, prostate, ...lung, or colorectal cancer who chose AM, administered as sole anticancer treatment among patients who did not receive conventional cancer treatment (CCT), defined as chemotherapy, radiotherapy, surgery, and/or hormone therapy. Independent covariates on multivariable logistic regression associated with increased likelihood of AM use included breast or lung cancer, higher socioeconomic status, Intermountain West or Pacific location, stage II or III disease, and low comorbidity score. Following 2:1 matching (CCT = 560 patients and AM = 280 patients) on Cox proportional hazards regression, AM use was independently associated with greater risk of death compared with CCT overall (hazard ratio HR = 2.50, 95% confidence interval CI = 1.88 to 3.27) and in subgroups with breast (HR = 5.68, 95% CI = 3.22 to 10.04), lung (HR = 2.17, 95% CI = 1.42 to 3.32), and colorectal cancer (HR = 4.57, 95% CI = 1.66 to 12.61). Although rare, AM utilization for curable cancer without any CCT is associated with greater risk of death.
Suicide among cancer patients Zaorsky, Nicholas G; Zhang, Ying; Tuanquin, Leonard ...
Nature communications,
01/2019, Letnik:
10, Številka:
1
Journal Article
Recenzirano
Odprti dostop
Our purpose is to identify cancer patients at highest risk of suicide compared to the general population and other cancer patients. This is a retrospective, population-based study using nationally ...representative data from the Surveillance, Epidemiology, and End Results program, 1973-2014. Among 8,651,569 cancer patients, 13,311 committed suicide; the rate of suicide was 28.58/ 100,000-person years, and the standardized mortality ratio (SMR) of suicide was 4.44 (95% CI, 4.33, 4.55). The predominant patients who committed suicide were male (83%) and white (92%). Cancers of the lung, head and neck, testes, bladder, and Hodgkin lymphoma had the highest SMRs ( > 5-10) through the follow up period. Elderly, white, unmarried males with localized disease are at highest risk vs other cancer patients. Among those diagnosed at < 50 years of age, the plurality of suicides is from hematologic and testicular tumors; if > 50, from prostate, lung, and colorectal cancer patients.
Extranodal extension (ENE) is a well-established poor prognosticator and an indication for adjuvant treatment escalation in patients with head and neck squamous cell carcinoma (HNSCC). Identification ...of ENE on pretreatment imaging represents a diagnostic challenge that limits its clinical utility. We previously developed a deep learning algorithm that identifies ENE on pretreatment computed tomography (CT) imaging in patients with HNSCC. We sought to validate our algorithm performance for patients from a diverse set of institutions and compare its diagnostic ability to that of expert diagnosticians.
We obtained preoperative, contrast-enhanced CT scans and corresponding pathology results from two external data sets of patients with HNSCC: an external institution and The Cancer Genome Atlas (TCGA) HNSCC imaging data. Lymph nodes were segmented and annotated as ENE-positive or ENE-negative on the basis of pathologic confirmation. Deep learning algorithm performance was evaluated and compared directly to two board-certified neuroradiologists.
A total of 200 lymph nodes were examined in the external validation data sets. For lymph nodes from the external institution, the algorithm achieved an area under the receiver operating characteristic curve (AUC) of 0.84 (83.1% accuracy), outperforming radiologists' AUCs of 0.70 and 0.71 (
= .02 and
= .01). Similarly, for lymph nodes from the TCGA, the algorithm achieved an AUC of 0.90 (88.6% accuracy), outperforming radiologist AUCs of 0.60 and 0.82 (
< .0001 and
= .16). Radiologist diagnostic accuracy improved when receiving deep learning assistance.
Deep learning successfully identified ENE on pretreatment imaging across multiple institutions, exceeding the diagnostic ability of radiologists with specialized head and neck experience. Our findings suggest that deep learning has utility in the identification of ENE in patients with HNSCC and has the potential to be integrated into clinical decision making.
Electrochemical processes occurring at solid/solid and solid/membrane interfaces govern the behavior of a variety of energy storage devices, including electrocatalytic reactions at electrode/membrane ...interfaces in fuel cells and ion insertion at electrode/electrolyte interfaces in solid-state batteries. Due to the heterogeneity of these systems, interrogation of interfacial activity at nanometer length scales is desired to understand system performance, yet the buried nature of the interfaces makes localized activity inaccessible to conventional electrochemical techniques. Herein, we demonstrate nanoscale electrochemical imaging of hydrogen evolution at individual Pt nanoparticles (PtNPs) positioned at a buried interface using scanning electrochemical cell microscopy (SECCM). Specifically, we image the hydrogen evolution reaction (HER) at individual carbon-supported PtNP electrocatalysts covered by a 100 to 800 nm thick layer of the proton exchange membrane Nafion. The rate of hydrogen evolution at PtNP at this buried interface is shown to be a function of Nafion thickness, with the highest activity observed for ∼200 nm thick films.
Identification of nodal metastasis and tumor extranodal extension (ENE) is crucial for head and neck cancer management, but currently only can be diagnosed via postoperative pathology. Pretreatment, ...radiographic identification of ENE, in particular, has proven extremely difficult for clinicians, but would be greatly influential in guiding patient management. Here, we show that a deep learning convolutional neural network can be trained to identify nodal metastasis and ENE with excellent performance that surpasses what human clinicians have historically achieved. We trained a 3-dimensional convolutional neural network using a dataset of 2,875 CT-segmented lymph node samples with correlating pathology labels, cross-validated and fine-tuned on 124 samples, and conducted testing on a blinded test set of 131 samples. On the blinded test set, the model predicted ENE and nodal metastasis each with area under the receiver operating characteristic curve (AUC) of 0.91 (95%CI: 0.85-0.97). The model has the potential for use as a clinical decision-making tool to help guide head and neck cancer patient management.
Objective(s)
Describe recent national trends in overall treatment modalities for T1 glottic squamous cell carcinomas (SCC), and identify factors associated with treatment regimens.
Methods
National ...Cancer Database from 2004–2020 was queried for all patients with glottic cT1N0M0 SCC. Treatment patterns over time were analyzed using the Cochran‐Armitage test for trend. Multivariable logistic regressions were used to determine the factors associated with treatment regimens.
Results
Of the 22,414 patients identified, most patients received RT only (57%), 21% received surgery only, and 22% received dual‐modality treatment (“over‐treatment”). Over the time period, there was a decreasing trend in rates of over‐treatment for T1 glottic SCC (p < 0.001) and an increasing trend in surgery only (p < 0.001). Treatment in 2016–2018 (OR: 1.168 1.004 to 1.359), 2013–2015 (OR: 1.419 1.221 to 1.648), 2010–2012 (OR: 1.611 1.388 to 1.871), 2007–2009 (OR: 1.682 1.450 to 1.951), or 2004–2006 (OR: 1.795 1.548 to 2.081) versus 2019–2020 was associated with greater likelihood of over‐treatment. T1b tumors were less likely to be over‐treated (OR: 0.795 0.707 to 0.894) versus T1a tumors, and less likely to receive surgery first (OR: 0.536 0.485 to 0.592) versus T1a tumors.
Conclusion
Over‐treatment for T1 glottic SCC has been declining, with increasing rates of surgery only. Year of treatment was significantly associated with the receipt of dual‐modality treatment. Finally, patients with T1b disease were more likely to receive RT as the first and only treatment.
Level of Evidence
3 Laryngoscope, 134:3633–3644, 2024
There is still debate on whether surgery or radiotherapy (RT) is superior as the first‐line therapy for patients with T1 glottic squamous cell carcinomas (SCC). This study sought to describe recent national trends in overall treatment modalities for these cancers, and identify factors associated with treatment regimens. Dual‐modality treatment with both surgery and radiotherapy for T1 glottic SCC has been declining while rates of surgery only have been increasing; patients with T1b disease were more likely to receive RT as the first and only treatment.
There is limited information on the association among complementary medicine (CM), adherence to conventional cancer treatment (CCT), and overall survival of patients with cancer who receive CM ...compared with those who do not receive CM.
To compare overall survival between patients with cancer receiving CCT with or without CM and to compare adherence to treatment and characteristics of patients receiving CCT with or without CM.
This retrospective observational study used data from the National Cancer Database on 1 901 815 patients from 1500 Commission on Cancer-accredited centers across the United States who were diagnosed with nonmetastatic breast, prostate, lung, or colorectal cancer between January 1, 2004, and December 31, 2013. Patients were matched on age, clinical group stage, Charlson-Deyo comorbidity score, insurance type, race/ethnicity, year of diagnosis, and cancer type. Statistical analysis was conducted from November 8, 2017, to April 9, 2018.
Use of CM was defined as "Other-Unproven: Cancer treatments administered by nonmedical personnel" in addition to at least 1 CCT modality, defined as surgery, radiotherapy, chemotherapy, and/or hormone therapy.
Overall survival, adherence to treatment, and patient characteristics.
The entire cohort comprised 1 901 815 patients with cancer (258 patients in the CM group and 1 901 557 patients in the control group). In the main analyses following matching, 258 patients (199 women and 59 men; mean age, 56 years interquartile range, 48-64 years) were in the CM group, and 1032 patients (798 women and 234 men; mean age, 56 years interquartile range, 48-64 years) were in the control group. Patients who chose CM did not have a longer delay to initiation of CCT but had higher refusal rates of surgery (7.0% 18 of 258 vs 0.1% 1 of 1031; P < .001), chemotherapy (34.1% 88 of 258 vs 3.2% 33 of 1032; P < .001), radiotherapy (53.0% 106 of 200 vs 2.3% 16 of 711; P < .001), and hormone therapy (33.7% 87 of 258 vs 2.8% 29 of 1032; P < .001). Use of CM was associated with poorer 5-year overall survival compared with no CM (82.2% 95% CI, 76.0%-87.0% vs 86.6% 95% CI, 84.0%-88.9%; P = .001) and was independently associated with greater risk of death (hazard ratio, 2.08; 95% CI, 1.50-2.90) in a multivariate model that did not include treatment delay or refusal. However, there was no significant association between CM and survival once treatment delay or refusal was included in the model (hazard ratio, 1.39; 95% CI, 0.83-2.33).
In this study, patients who received CM were more likely to refuse additional CCT, and had a higher risk of death. The results suggest that mortality risk associated with CM was mediated by the refusal of CCT.
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