Background
Radiofrequency ablation (RFA) for thyroid nodules has recently been introduced into the United States healthcare system landscape. Little is known about the process of incorporating this ...procedure into existing clinical practice.
Methods
A retrospective chart review of a single institution was conducted to examine referral patterns and decision‐making after the introduction of RFA into an endocrine surgery‐focused practice. Patient demographics and thyroid‐specific data were recorded. Two reviewers ed and coded reasons for the noncompletion of RFA. Two‐sample t tests were used to compare groups; linear regression was used to assess trends and practice patterns.
Results
Chart review identified 451 patients referred for consideration of RFA from January 2020 to December 2022. Only 255 (56.5%) went on to receive the treatment. There was no significant difference in nodule volume between treated and nontreated groups (18.5 vs. 14.9 cm3, p = 0.07). Concern for malignancy on genetic testing, size (too large/too small), recommendation for Ethanol ablation, and multinodular disease without target nodules were the most common reasons for physician deferral. Of patients who declined to proceed, 46% opted to undergo surgical excision. Linear regression showed that referral numbers significantly increased with time; however, the proportion of patients receiving treatment decreased yearly, primarily because of higher rates of physician deferral.
Conclusions
This study reflects the complex decision‐making in offering minimally invasive thyroid nodule ablation. Despite a greater number of referrals over time, physician criteria became increasingly selective. Optimal candidacy in RFA is an evolving determination requiring patient and physician input to guide ideal practice patterns.
Background
There are a growing number of cancer survivors in the United States who are at risk for chronic pain due to cancer disease and treatments. The prevalence of chronic pain among cancer ...survivors has not been comprehensively reported.
Methods
This study used data from the National Health Interview Survey (2010‐2017) to compare the prevalence of chronic pain between participants with a cancer diagnosis and participants without one. Adjusted odds ratios (AORs) of having chronic pain were assessed by multivariable logistic regression, which included an age (less than the median age vs greater than or equal to the median age) × cancer diagnosis (yes vs no) interaction term. Among cancer survivors, multivariable logistic regression defined the odds of feeling depressed, feeling worried/nervous/anxious, being unable to work, and needing assistance for activities of daily living (ADLs) and instrumental activities of daily living (IADLs).
Results
Among 115,091 participants, a cancer diagnosis was associated with an increased AOR of chronic pain in comparison with the general population (30.8% vs 15.7%; AOR, 1.48; 95% confidence interval, 1.38‐1.59). Older age was associated with higher odds of chronic pain (P < .001 across all increasing age categories); however, the positive association between older age and chronic pain was seen only in participants without cancer and was not seen in those with a cancer diagnosis (Page×cancer < .001). Among patients reporting a cancer diagnosis, chronic pain was associated with greater odds of feeling depressed, feeling worried/nervous/anxious, being unable to work, and needing assistance with ADLs or IADLs (P < .001 for all).
Conclusions
Cancer survivors appear to have a high prevalence of chronic pain, which is associated with worse mental, functional, and employment outcomes. Screening and management of chronic pain should be addressed by policymakers to improve cancer survivorship care.
In this nationally representative study, approximately one‐third of cancer survivors report having chronic pain; this is nearly double the prevalence in the general population. Among cancer survivors, the presence of chronic pain is associated with worse mental, functional, and employment outcomes.
Background
We sought to determine the extent to which US Preventive Services Task Force (USPSTF) 2012 Grade D recommendations against prostate‐specific antigen screening may have impacted recent ...prostate cancer disease incidence patterns in the United States across stage, National Comprehensive Cancer Network (NCCN) risk groups, and age groups.
Methods
SEER*Stat version 8.3.4 was used to calculate annual prostate cancer incidence rates from 2010 to 2015 for men aged ≥50 years according to American Joint Committee on Cancer stage at diagnosis (localized vs metastatic), NCCN risk group (low vs unfavorable intermediate or high‐risk), and age group (50‐74 years vs ≥75 years). Age‐adjusted incidences per 100,000 persons with corresponding year‐by‐year incidence ratios (IRs) were calculated using the 2000 US Census population.
Results
From 2010 to 2015, the incidence (per 100,000 persons) of localized prostate cancer decreased from 195.4 to 131.9 (Ptrend < .001) and from 189.0 to 123.4 (Ptrend < .001) among men aged 50‐74 and ≥75 years, respectively. The largest relative year‐by‐year decline occurred between 2011 and 2012 in NCCN low‐risk disease (IR, 0.77 0.75–0.79, P < .0001 and IR 0.68 0.62–0.74, P < .0001 for men aged 50‐74 and ≥75 years, respectively). From 2010‐2015, the incidence of metastatic disease increased from 6.2 to 7.1 (Ptrend < .001) and from 16.8 to 22.6 (Ptrend < .001) among men aged 50‐74 and ≥75 years, respectively.
Conclusions
This report illustrates recent prostate cancer “reverse migration” away from indolent disease and toward more aggressive disease beginning in 2012. The incidence of localized disease declined across age groups from 2012 to 2015, with the greatest relative declines occurring in low‐risk disease. Additionally, the incidence of distant metastatic disease increased gradually throughout the study period.
This report illustrates a recent “reverse migration” of prostate cancer away from indolent disease and toward more aggressive disease beginning in 2012. The incidence of localized disease has declined across age groups from 2012 to 2015—with the greatest relative declines occurring in low‐risk disease—while the incidence of distant metastatic disease has gradually increased.
Background
Certain patients with intermediate‐risk prostate cancer (PCa) may be appropriate candidates for active surveillance (AS). In the current study, the authors sought to characterize AS use ...and early mortality outcomes for patients with intermediate‐risk PCa in the United States.
Methods
The novel Surveillance, Epidemiology, and End Results Active Surveillance/Watchful Waiting database identified 52,940 men diagnosed with National Comprehensive Cancer Network intermediate‐risk PCa (cT2b‐c, Gleason score of 7, or a prostate‐specific antigen level of 10‐20 ng/mL) and actively managed (AS, radiotherapy, or radical prostatectomy) from 2010 through 2015. The Cuzick test assessed AS time trends, and logistic multivariable regression characterized features associated with AS. Fine‐Gray and Cox modeling determined PCa‐specific mortality (PCSM) and overall survival, respectively.
Results
The rate of AS increased from 3.7% in 2010 to 7.3% in 2015, and from 7.2% to 11.7% among men aged ≥70 years. Among men with favorable and unfavorable intermediate‐risk disease, the use of AS increased from 7.2% to 14.9% and from 2.2% to 3.8%, respectively (all P value for trend, <.001). The mean age of those patients managed with AS decreased from 69.9 years to 67.9 years (P = .0004). Factors found to be associated with AS included favorable risk disease; black race; higher socioeconomic status; older age; and diagnosis in the West, Northwest, or Midwest regions of the United States. The 5‐year PCSM rate was comparable to AS versus treatment among patients with low‐risk and favorable intermediate‐risk disease, but was worse with AS among those with unfavorable intermediate‐risk disease (PCSM, 1.3% vs 0.5%; adjusted hazard ratio, 2.48 95% CI, 1.11‐5.50; P = .026) and intermediate‐risk disease overall (PCSM, 1.1% vs 0.4%; adjusted hazard ratio, 2.34 95% CI, 1.25‐4.37; P = .008).
Conclusions
The use of AS for patients with intermediate‐risk PCa is increasing across the United States, particularly for older men and those with favorable intermediate‐risk disease. Early estimates of cancer‐specific and overall mortality rates are low with AS, although significantly higher compared with treatment.
The use of active surveillance (AS) for patients diagnosed with intermediate‐risk prostate cancer is rising across the United States, particularly among older men and those with favorable intermediate‐risk disease. Early estimates of cancer‐specific and overall mortality rates are low with AS, although significantly higher compared with treatment.
Background
There is substantial variation in head and neck cancer (HNC) mortality and competing mortality among patients with HNC. In this study, the authors characterize the causes and risks of ...short‐term mortality among patients with oropharynx cancer (OPC) and how these risks differ by human papillomavirus (HPV) status.
Methods
A custom Surveillance, Epidemiology, and End Results (SEER) data set with HPV status was used to identify 4930 patients with OPC who were diagnosed with nonmetastatic (M0) disease from 2013 to 2014, including 3560 (72.2%) HPV‐positive patients and 1370 HPV‐negative patients. Causes of death and cumulative incidence estimates for HNC‐specific mortality, competing mortality, second‐cancer mortality, and noncancer mortality were analyzed by HPV status. Risk factors for mortality events were determined using multivariable competing risk regression models.
Results
Compared with HPV‐negative patients, HPV‐positive patients had a lower risk of 2‐year cumulative incidence of all‐cause mortality (10.4% vs 33.3%; P < .0001) and a lower risk of both HNC‐specific mortality (4.8% vs 16.2%; P < .0001) and competing‐cause mortality (5.6% vs 16.8%; P < .0001). Second‐cancer mortality was the most common cause of non‐HNC mortality among HPV‐negative patients. Both second‐cancer mortality and noncancer mortality were significantly higher among patients who had HPV‐negative OPC (10.8% and 6.1%, respectively) compared with those who had HPV‐positive OPC (2.4% and 3.2%, respectively; both P < .0001). The median follow‐up was 11 months (range 1‐23 months) in this cohort with known HPV‐status.
Conclusions
Patients with HPV‐positive and HPV‐negative OPC have significantly different rates of both HNC mortality and competing mortality. HPV‐negative patients are at substantial risk of competing mortality, even within 2 years of cancer diagnosis. These differences can inform power calculations for clinical trials and patient management in the acute and survivorship settings.
Patients with human papillomavirus (HPV)‐positive and HPV‐negative oropharyngeal cancer have significantly different risks of both head and neck cancer–specific and competing mortality, and HPV‐negative patients are at a substantial risk of short‐term competing risks of mortality after diagnosis and treatment of head and neck cancer. These differences can inform power calculations for clinical trials and patient management in the acute and survivorship settings.
Background
A growing proportion of cancer survivors experience financial toxicity. However, the psychological burden of cancer costs and associated mental health outcomes require further ...investigation. We assessed prevalence and predictors of self-reported financial worry and mental health outcomes among cancer survivors.
Patients and methods
Data from the 2013–2018 National Health Interview Survey (NHIS) for adults reporting a cancer diagnosis were used. Multivariable ordinal logistic regressions defined adjusted odds ratios (AORs) of reporting financial worry by relevant sociodemographic variables, and sample weight-adjusted prevalence of financial worry was estimated. The association between financial worry and psychological distress, as defined by the six-item Kessler Psychological Distress Scale was also assessed.
Results
Among 13,361 survey participants (median age 67; 60.0% female), 9567 (71.6%) self-reported financial worry, including worries regarding costs of paying for children’s college education (62.7%), maintaining one’s standard of living (59.7%), and medical costs due to illness or accident (58.3%). Female sex, younger age, and Asian American race were associated with increased odds of financial worry (
P
< 0.05 for all). Of 13,218 participants with complete responses to K6 questions, 701 (5.3%) met the threshold for severe psychological distress. Participants endorsing financial worry were more likely to have psychological distress (6.6 vs. 1.2%, AOR 2.89, 95% CI 2.03–4.13,
P
< 0.001) with each additional worry conferring 23.9% increased likelihood of psychological distress.
Conclusions
A majority of cancer survivors reported financial worry, which was associated with greater odds of reporting psychological distress. Policies and guidelines are needed to identify and mitigate financial worries and psychologic distress among patients with cancer, with the goal of improving psychological well-being and overall cancer survivorship care.
BACKGROUND
For men with radiation‐managed prostate cancer, there is conflicting evidence regarding the association between androgen deprivation therapy (ADT) and cardiovascular mortality (CVM), ...particularly among those who have with preexisting comorbidities. The objective of this study was to analyze the association between ADT and CVM across patient comorbidity status using prospectively collected data from a large clinical trial.
METHODS
In total, 1463 men were identified who were diagnosed with clinically localized, intermediate‐risk/high‐risk prostate cancer (T2b‐T4, Gleason 7‐10, or prostate‐specific antigen >10 ng/mL) from 1993 to 2001 and managed with either radiation therapy (RT) alone or RT plus ADT during the randomized Prostate, Lung, Colon, and Ovarian (PLCO) Cancer Screening Trial. Adjusted hazard ratios (aHRs) for cause‐specific mortality (prostate cancer‐specific mortality vs other‐cause mortality—including the primary end point of CVM death from ischemic heart disease, cerebrovascular accident, or other circulatory disease) were determined using Fine and Gray competing‐risk regression analysis and stratified by comorbidity history.
RESULTS
There was no difference in the risk of 5‐year CVM between ADT plus RT and RT alone (2.3% vs 3.3%, respectively; aHR, 0.69; 95% CI, 0.38‐1.24; P = .21) overall or on subgroup analysis among men with a history of ≥1 preexisting comorbidities (3.2% vs 5.3%, respectively; aHR, 0.83; 95% CI, 0.43‐1.60; P = .58), ≥2 preexisting comorbidities (6.9% vs 8.3%, respectively; aHR, 0.95; 95% CI, 0.40‐2.25; P = .90), or cardiovascular disease/risk factors (3.6% vs 4.3%, respectively; aHR, 0.85; 95% CI, 0.44‐1.65; P = .63). These results were all similar when each component of CVM was analyzed separately—either cardiac, stroke, or other vascular mortality (P > .05).
CONCLUSIONS
This study provides prospectively collected evidence that the use of ADT plus RT, compared with RT alone, is not associated with an increased risk of CVM, even among subgroups of men who have preexisting comorbidities and cardiovascular disease.
In this secondary analysis of a prospective trial of 1463 men with radiation‐treated, localized, intermediate‐risk/high‐risk prostate cancer, 5‐year cardiovascular mortality is comparable between androgen deprivation therapy plus radiation therapy and radiation therapy alone (overall, 2.3% vs 3.3%, respectively), even among those who have preexisting comorbidities or cardiovascular disease.
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