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Inequities in palliative care delivery to patients with HIV and Stage IV cancers in the US (2004-2020). 美国为 HIV 感染者和 IV 期癌症患者提供姑息关怀服务的不公平现象(2004-2020 年)。
IF 3.4 Q2 ONCOLOGY Pub Date : 2024-11-23 DOI: 10.1093/jncics/pkae118
Jessica Y Islam, Yi Guo, Kea Turner, Amir Alishahi Tabriz, Yu Chen Lin, Denise C Vidot, Susan T Vadaparampil, Anna E Coghill, Marlene Camacho-Rivera ScD, Gita Suneja

Background: People with HIV (PWH) diagnosed with stage-IV cancer are less likely to receive palliative care (PC) compared to those without HIV. Our objective was to evaluate inequities in PC receipt among PWH with stage IV cancer in the US.

Methods: We used the National Cancer Database (2004-2020), including adult (18-89 years) PWH with the 14 most common cancers that occur among PWH. PC was defined as treatment provided with non-curative intent. Our main exposures included % quartiles of adults without a high school degree (educational attainment) and median income quartiles within the patient's zip code. We used hierarchical multivariable Poisson regression to estimate adjusted prevalence ratios(aPR) with 95% confidence intervals (95% CI), adjusting for age, sex, year of diagnosis, race/ethnicity, and cancer type.

Results: Among the included 10,120 PWH with stage IV cancer, 72% were men, 51% were either non-Hispanic(NH)-Black or Hispanic/Latinx, 38% were aged ≥60 years, and 97% resided in urban areas. Fourteen percent received PC. NH-Black PWH living in zip-codes with lower quartiles of educational attainment were more likely to receive PC compared to those in the highest quartile (Q1vs.Q4: aPR:1.93;95% CI:1.29-2,86) For income overall, compared to those in the highest quartile (Q4) of income, those in the lowest quartile had 26% higher likelihood of receiving PC (Q1vs.Q4: aPR:1.26;95% CI:1.05-1.52), particularly among NH-Black adults (Q1vs.Q4: aPR:1.67;95% CI:1.25-2.22; Q2 vs.Q4; aPR:1.48;95% CI:1.09-2.01).

Conclusions: PC use among PWH with stage-IV cancer is low. Contextual poverty plays a role in PC delivery to PWH and cancer, particularly among NH-Black PWH.

背景:被诊断为 IV 期癌症的艾滋病病毒感染者(PWH)与非艾滋病病毒感染者相比,接受姑息关怀(PC)的可能性较低。我们的目的是评估美国 IV 期癌症患者中接受姑息治疗的不平等现象:我们使用了全国癌症数据库(2004-2020 年),其中包括罹患 14 种最常见癌症的成年(18-89 岁)艾滋病感染者。PC定义为非治愈性治疗。我们的主要暴露因素包括患者所在邮政编码内没有高中学历(受教育程度)的成人比例四分位数和收入中位数四分位数。我们使用分层多变量泊松回归法估算了调整后的患病率(aPR)和 95% 置信区间(95% CI),并对年龄、性别、诊断年份、种族/民族和癌症类型进行了调整:在纳入的 10,120 名 IV 期癌症患者中,72% 为男性,51% 为非西班牙裔黑人或西班牙裔/拉丁裔,38% 年龄≥60 岁,97% 居住在城市地区。14% 接受了 PC 治疗。与教育程度最高的四分位数的人群相比,居住在教育程度较低的四分位数邮政编码下的新罕布什尔州黑人公共卫生人员更有可能接受个人护理(Q1vs.Q4: aPR:1.93;95% CI:1.总体收入方面,与收入最高四分位数(Q4)的人群相比,收入最低四分位数的人群接受 PC 的可能性高出 26%(Q1vs.Q4: aPR:1.26;95% CI:1.05-1.52 ),尤其是在新罕布什尔州黑人成年人中(Q1vs.Q4: aPR:1.67;95% CI:1.25-2.22; Q2 vs.Q4; aPR:1.48;95% CI:1.09-2.01 ):患有 IV 期癌症的残疾人使用 PC 的比例较低。结论:在罹患 IV 期癌症的残疾人中,PC 的使用率很低。贫困环境对向残疾人和癌症患者提供 PC 起到了一定作用,尤其是在新罕布什尔州的黑人残疾人中。
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引用次数: 0
Trilaciclib prior to FOLFOXIRI/bevacizumab for patients with untreated metastatic colorectal cancer: phase 3 PRESERVE 1 trial. 用于未经治疗的转移性结直肠癌患者的 FOLFOXIRI/bevacizumab 治疗前的 Trilaciclib:3 期 PRESERVE 1 试验。
IF 3.4 Q2 ONCOLOGY Pub Date : 2024-11-23 DOI: 10.1093/jncics/pkae116
Heinz-Josef Lenz, Tianshu Liu, Emerson Y Chen, Zsolt Horváth, Igor Bondarenko, Iwona Danielewicz, Michele Ghidini, Pilar García-Alfonso, Robert Jones, Matti Aapro, Yanqiao Zhang, Jufeng Wang, Wayne Wang, Jennifer Adeleye, Andrew Beelen, Joleen Hubbard

Background: In metastatic colorectal cancer (mCRC), improvements in survival from combining leucovorin/fluorouracil/oxaliplatin/irinotecan (FOLFOXIRI) with bevacizumab have come at the risk of increased rates of high-grade toxicities. Trilaciclib is indicated to decrease the incidence of chemotherapy-induced myelosuppression in patients receiving standard-of-care chemotherapy for extensive-stage small cell lung cancer.

Methods: Patients with untreated mCRC were randomized 1:1 to trilaciclib (n = 164) or placebo (n = 162) prior to FOLFOXIRI/bevacizumab for up to 12 cycles (induction), followed by trilaciclib or placebo prior to fluorouracil/leucovorin/bevacizumab (maintenance). Co-primary endpoints were duration of severe (grade 4) neutropenia (DSN) in cycles 1-4 and occurrence of severe neutropenia (SN) during induction. Secondary endpoints included antitumor efficacy, survival, and safety.

Results: : The study met its co-primary endpoints. Administering trilaciclib prior to FOLFOXIRI/bevacizumab resulted in significant reductions in DSN in cycles 1-4 versus placebo (mean, 0.1 vs. 1.3 days; P < .001) and occurrence of SN during induction (1.3% vs. 19.7%; adjusted relative risk [96% CI], 0.07 [0.0, 0.3]; P < .001). Grade 3/4 adverse events, including neutropenia, diarrhea, and leukopenia, were less frequent with trilaciclib versus placebo (64.8% vs. 73.1%). Trilaciclib was associated with fewer chemotherapy dose reductions and delays, and reduced administration of supportive therapies, compared with placebo. Objective response rate (41.6% vs. 57.1%; P = .009) and median progression-free survival (10.3 vs. 13.1 months; P < .001) were significantly lower with trilaciclib versus placebo.

Conclusions: : Administering trilaciclib prior to FOLFOXIRI/bevacizumab protected the neutrophil lineage from the effects of chemotherapy-induced myelosuppression. However, antitumor efficacy endpoints favored placebo.

背景:在转移性结直肠癌(mCRC)中,亮菌甲素/氟尿嘧啶/奥沙利铂/伊立替康(FOLFOXIRI)与贝伐珠单抗联用可提高患者的生存率,但也有可能增加高毒性反应的发生率。Trilaciclib适用于降低接受标准化疗的广泛期小细胞肺癌患者化疗引起的骨髓抑制发生率:将未经治疗的mCRC患者按1:1随机分组,在FOLFOXIRI/贝伐珠单抗最多12个周期(诱导)前服用曲拉西利布(n = 164)或安慰剂(n = 162),然后在氟尿嘧啶/亮紫杉醇/贝伐珠单抗(维持治疗)前服用曲拉西利布或安慰剂。共主要终点是第1-4周期的严重(4级)中性粒细胞减少症(DSN)持续时间和诱导期间的严重中性粒细胞减少症(SN)发生率。次要终点包括抗肿瘤疗效、生存期和安全性:研究达到了共同主要终点。在FOLFOXIRI/贝伐单抗治疗前服用曲拉西利布可显著减少1-4周期与安慰剂相比的DSN(平均0.1天 vs. 1.3天;P < .001)和诱导期间的SN发生率(1.3% vs. 19.7%;调整相对风险[96% CI],0.07 [0.0, 0.3];P < .001)。曲拉克利与安慰剂相比,3/4级不良事件(包括中性粒细胞减少、腹泻和白细胞减少)发生率较低(64.8% vs. 73.1%)。与安慰剂相比,曲拉西利布导致的化疗剂量减少和延迟以及支持性疗法用药减少的情况更少。与安慰剂相比,trilaciclib的客观反应率(41.6% vs. 57.1%;P = .009)和中位无进展生存期(10.3个月 vs. 13.1个月;P < .001)显著降低:结论:在FOLFOXIRI/贝伐单抗治疗前服用曲拉西利布可保护中性粒细胞免受化疗引起的骨髓抑制的影响。然而,抗肿瘤疗效终点更倾向于安慰剂。
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引用次数: 0
Association of Race and Area of Deprivation Index with Prostate Cancer Incidence and Lethality. 种族和贫困地区指数与前列腺癌发病率和死亡率的关系。
IF 3.4 Q2 ONCOLOGY Pub Date : 2024-11-22 DOI: 10.1093/jncics/pkae112
Marco Finati, Alex Stephens, Giuseppe Ottone Cirulli, Giuseppe Chiarelli, Shane Tinsley, Chase Morrison, Akshay Sood, Nicolò Buffi, Giovanni Lughezzani, Andrea Salonia, Alberto Briganti, Francesco Montorsi, Gian Maria Busetto, Craig Rogers, Giuseppe Carrieri, Firas Abdollah

Background: Socio-economic and demographical factors contribute to disparity in prostate cancer (PCa) outcomes. We examined the impact of area of deprivation index (ADI) and race on PCa incidence and lethality in a North-American cohort.

Methods: Our cohort included men who received at least one PSA test within our Health System (1995-2022). An ADI score was assigned to each patient based on their residential census block, ranked as a percentile of deprivation relative to the national level. Individuals were further categorized into quartiles, where the fourth one (ADI 75-100) represented those living in the most deprived areas. We investigated PCa incidence and lethality, using cumulative incidence estimates and competing-risk regression. An ADIxRace interaction term examined whether the relationship between ADI and outcomes varied based on race.

Results: We included 134,366 patients, 25% of whom were NHB. Median (IQR) follow-up was 8.8 (5-17) years. At multivariate analysis, individuals from the third (ADI 50-74, 95% CI: 0.83-0.95) and the fourth quartile (ADI ≥ 75, 95% CI: 0.75-0.86) showed significant reduced HRs for PCa incidence, when compared with the first quartile (ADI < 25, all p < .001). In contrast to the overall cohort, PCa incidence increased with ADI in NHB men, who were persistently at higher hazard for both PCa incidence and lethality than NHW, across all ADI strata (all p < .001).

Conclusions: Living in more deprived areas was associated with lower PCa incidence and higher lethal disease rate. Conversely, PCa incidence increased with ADI for NHB, who consistently showed worse outcomes than NHW individuals, regardless of ADI.

背景:社会经济和人口因素导致了前列腺癌(PCa)结果的差异。我们研究了北美队列中贫困地区指数(ADI)和种族对 PCa 发病率和致死率的影响:我们的队列包括在我们的卫生系统内至少接受过一次 PSA 检测的男性(1995-2022 年)。我们根据每位患者的居住地人口普查区为其分配了 ADI 分数,并将其作为相对于全国水平的贫困百分位数进行排名。患者被进一步分为四等分,其中第四等分(ADI 75-100)代表生活在最贫困地区的患者。我们使用累积发病率估计值和竞争风险回归法调查了 PCa 发病率和致死率。ADIx种族交互项检验了ADI与结果之间的关系是否因种族而异:我们共纳入了 134366 名患者,其中 25% 为非黑种人。随访中位数(IQR)为 8.8 (5-17) 年。在多变量分析中,与第一四分位数(ADI)相比,第三四分位数(ADI 50-74,95% CI:0.83-0.95)和第四四分位数(ADI ≥ 75,95% CI:0.75-0.86)的个体显示 PCa 发病率的 HR 显著降低:生活在较贫困地区与较低的 PCa 发病率和较高的致死率有关。相反,NHB 的 PCa 发病率随着 ADI 的增加而增加,无论 ADI 如何,NHB 的预后都比 NHW 差。
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引用次数: 0
Rural-Urban Disparities and Trends in Cancer Screening: An Analysis of Behavioral Risk Factor Surveillance System Data (2018-2022). 癌症筛查中的城乡差异与趋势:行为风险因素监测系统数据分析(2018-2022 年)》。
IF 3.4 Q2 ONCOLOGY Pub Date : 2024-11-09 DOI: 10.1093/jncics/pkae113
Gabriel A Benavidez, Ami E Sedani, Tisha M Felder, Matthew Asare, Charles R Rogers

Background: Despite evidence of the benefit of routine cancer screenings, data show a concerning decline in cancer screening uptake for multiple cancer screenings. This analysis aimed to examine rural-urban differences in recent trends for being up to date with screenings for breast, cervical, and colorectal cancers.

Methods: We used 2018, 2020, and 2022 Behavioral Risk Factor Surveillance System data to assess up-to-date cancer screening status among eligible U.S. adults. We calculated weighted prevalence estimates overall and stratified by county-level rural-urban classification. We used survey-weighted multivariable logistic regression models to examine rural-urban disparities in cancer screening up-to-date status by year.

Results: Prevalence of being up to date with each cancer screening was lower in 2022 than it was in 2018. The largest decline in screening overall was for cervical cancer that dropped from 81.89% in 2018 to 47.71% in 2022. Rural-urban disparities were observed for breast cancer screening from 2018 to 2022 with the odds of up-to-date screening being 14% to 27% lower for rural populations than urban populations. For colorectal and cervical cancer, the odds of being up to date with screenings were lower for rural populations in 2018 and 2020, but there was no significant difference observed in 2022 (colorectal screening OR = 0.96; 95% CI: 0.90, 1.02) (cervical screening OR = 0.97; 95% CI: 0.93, 1.03).

Discussion: There is a concerning trend of decreasing uptake of cancer screenings, which will challenge future efforts in cancer prevention and control efforts. Efforts are needed to better understand factors contributing to the declining uptake of cancer screenings.

背景:尽管有证据表明常规癌症筛查有益,但数据显示多种癌症筛查的接受率下降令人担忧。这项分析旨在研究城乡居民在接受乳腺癌、宫颈癌和结直肠癌筛查方面的最新趋势差异:我们使用 2018 年、2020 年和 2022 年行为风险因素监测系统数据来评估符合条件的美国成年人的最新癌症筛查状况。我们计算了总体加权患病率估计值,并按县级城乡分类进行了分层。我们使用调查加权多变量逻辑回归模型来研究各年癌症筛查最新状态的城乡差异:2022年各项癌症筛查的最新筛查率均低于2018年。宫颈癌筛查总体下降幅度最大,从 2018 年的 81.89% 降至 2022 年的 47.71%。从 2018 年到 2022 年,在乳腺癌筛查方面观察到了城乡差异,农村人口的最新筛查几率比城市人口低 14% 到 27%。在结直肠癌和宫颈癌筛查方面,2018 年和 2020 年农村人口的最新筛查几率较低,但 2022 年没有观察到显著差异(结直肠癌筛查 OR = 0.96;95% CI:0.90,1.02)(宫颈癌筛查 OR = 0.97;95% CI:0.93,1.03):癌症筛查率下降的趋势令人担忧,这将对未来的癌症预防和控制工作提出挑战。需要努力更好地了解导致癌症筛查率下降的因素。
{"title":"Rural-Urban Disparities and Trends in Cancer Screening: An Analysis of Behavioral Risk Factor Surveillance System Data (2018-2022).","authors":"Gabriel A Benavidez, Ami E Sedani, Tisha M Felder, Matthew Asare, Charles R Rogers","doi":"10.1093/jncics/pkae113","DOIUrl":"https://doi.org/10.1093/jncics/pkae113","url":null,"abstract":"<p><strong>Background: </strong>Despite evidence of the benefit of routine cancer screenings, data show a concerning decline in cancer screening uptake for multiple cancer screenings. This analysis aimed to examine rural-urban differences in recent trends for being up to date with screenings for breast, cervical, and colorectal cancers.</p><p><strong>Methods: </strong>We used 2018, 2020, and 2022 Behavioral Risk Factor Surveillance System data to assess up-to-date cancer screening status among eligible U.S. adults. We calculated weighted prevalence estimates overall and stratified by county-level rural-urban classification. We used survey-weighted multivariable logistic regression models to examine rural-urban disparities in cancer screening up-to-date status by year.</p><p><strong>Results: </strong>Prevalence of being up to date with each cancer screening was lower in 2022 than it was in 2018. The largest decline in screening overall was for cervical cancer that dropped from 81.89% in 2018 to 47.71% in 2022. Rural-urban disparities were observed for breast cancer screening from 2018 to 2022 with the odds of up-to-date screening being 14% to 27% lower for rural populations than urban populations. For colorectal and cervical cancer, the odds of being up to date with screenings were lower for rural populations in 2018 and 2020, but there was no significant difference observed in 2022 (colorectal screening OR = 0.96; 95% CI: 0.90, 1.02) (cervical screening OR = 0.97; 95% CI: 0.93, 1.03).</p><p><strong>Discussion: </strong>There is a concerning trend of decreasing uptake of cancer screenings, which will challenge future efforts in cancer prevention and control efforts. Efforts are needed to better understand factors contributing to the declining uptake of cancer screenings.</p>","PeriodicalId":14681,"journal":{"name":"JNCI Cancer Spectrum","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142620722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Association between GLP-1RA use and progression of MGUS to Multiple Myeloma among diabetic patients. 糖尿病患者使用 GLP-1RA 与 MGUS 进展为多发性骨髓瘤之间的关系。
IF 3.4 Q2 ONCOLOGY Pub Date : 2024-11-08 DOI: 10.1093/jncics/pkae095
Nikhil Grandhi, Lawrence Liu, Mei Wang, Theodore Thomas, Martin Schoen, Kristen Sanfilippo, Feng Gao, Graham A Colditz, Kenneth R Carson, Murali Janakiram, Su-Hsin Chang

Background: In patients with diabetes mellitus (DM) and monoclonal gammopathy of undetermined significance (MGUS), the impact of GLP-1 receptor agonists (GLP-1RAs) on the natural history of MGUS is unknown. We aimed to assess the association of GLP-1RA use in the progression of MGUS to multiple myeloma (MM) in patients with DM.

Methods: This is a population-based cohort study of Veterans diagnosed with MGUS from 2006-2021 with a prior diagnosis of DM. A validated natural language processing-algorithm was used to confirm MGUS and progression to MM. Gray's test was performed to detect the difference in cumulative Incidence functions (CIFs) for progression by GLP-1RA use status. The association between time-varying GLP-1RA use and progression was estimated in the 1 (exposed):2 (unexposed) matched cohort via multivariable-adjusted hazard ratio (aHR) using stratified Fine-Gray distribution hazard model with death as a competing event and stratum for the matched patient triad.

Results: Our analytic cohort included 1,097 MGUS patients who ever used GLP-1RAs, and the matched 2,194 patients who never used GLP-1RAs. Overall, 2.55% progressed in the GLP-1RA ever use group, compared to 5.01% in the GLP-1RA never use group. CIFs were significantly different between the exposed and unexposed groups (P = .02). GLP-1RA use, compared to no-use, was associated with decreased progression to MM (aHR 0.45, 95% confidence interval 0.22 to 0.93, P = .03).

Conclusions: For patients with DM and MGUS, GLP-1RA use is associated with a 55% reduction in risk of progression from MGUS to MM, compared to no use.

背景:在糖尿病(DM)和意义未定的单克隆丙种球蛋白病(MGUS)患者中,GLP-1受体激动剂(GLP-1RA)对MGUS自然史的影响尚不清楚。我们旨在评估使用 GLP-1RA 与 DM 患者的 MGUS 进展为多发性骨髓瘤(MM)之间的关联:这是一项基于人群的队列研究,研究对象是 2006-2021 年间被诊断为 MGUS 且之前诊断为 DM 的退伍军人。研究采用了一种经过验证的自然语言处理算法来确认MGUS和MM的进展。通过格雷氏检验来检测GLP-1RA使用状况对进展的累积发生率函数(CIF)的差异。在1(暴露):2(未暴露)配对队列中,使用分层Fine-Gray分布危险度模型,以死亡作为竞争事件,通过多变量调整危险度比(aHR)估算GLP-1RA使用时变与疾病进展之间的关系:我们的分析队列包括1097名曾经使用过GLP-1RAs的MGUS患者和2194名从未使用过GLP-1RAs的匹配患者。总体而言,曾使用 GLP-1RA 组中有 2.55% 的患者病情恶化,而从未使用 GLP-1RA 组中有 5.01%的患者病情恶化。暴露组和未暴露组的 CIF 有明显差异(P = 0.02)。与不使用GLP-1RA相比,使用GLP-1RA与MM进展的减少有关(aHR为0.45,95%置信区间为0.22至0.93,P = .03):结论:与不使用GLP-1RA相比,DM和MGUS患者使用GLP-1RA可将MGUS进展为MM的风险降低55%。
{"title":"Association between GLP-1RA use and progression of MGUS to Multiple Myeloma among diabetic patients.","authors":"Nikhil Grandhi, Lawrence Liu, Mei Wang, Theodore Thomas, Martin Schoen, Kristen Sanfilippo, Feng Gao, Graham A Colditz, Kenneth R Carson, Murali Janakiram, Su-Hsin Chang","doi":"10.1093/jncics/pkae095","DOIUrl":"https://doi.org/10.1093/jncics/pkae095","url":null,"abstract":"<p><strong>Background: </strong>In patients with diabetes mellitus (DM) and monoclonal gammopathy of undetermined significance (MGUS), the impact of GLP-1 receptor agonists (GLP-1RAs) on the natural history of MGUS is unknown. We aimed to assess the association of GLP-1RA use in the progression of MGUS to multiple myeloma (MM) in patients with DM.</p><p><strong>Methods: </strong>This is a population-based cohort study of Veterans diagnosed with MGUS from 2006-2021 with a prior diagnosis of DM. A validated natural language processing-algorithm was used to confirm MGUS and progression to MM. Gray's test was performed to detect the difference in cumulative Incidence functions (CIFs) for progression by GLP-1RA use status. The association between time-varying GLP-1RA use and progression was estimated in the 1 (exposed):2 (unexposed) matched cohort via multivariable-adjusted hazard ratio (aHR) using stratified Fine-Gray distribution hazard model with death as a competing event and stratum for the matched patient triad.</p><p><strong>Results: </strong>Our analytic cohort included 1,097 MGUS patients who ever used GLP-1RAs, and the matched 2,194 patients who never used GLP-1RAs. Overall, 2.55% progressed in the GLP-1RA ever use group, compared to 5.01% in the GLP-1RA never use group. CIFs were significantly different between the exposed and unexposed groups (P = .02). GLP-1RA use, compared to no-use, was associated with decreased progression to MM (aHR 0.45, 95% confidence interval 0.22 to 0.93, P = .03).</p><p><strong>Conclusions: </strong>For patients with DM and MGUS, GLP-1RA use is associated with a 55% reduction in risk of progression from MGUS to MM, compared to no use.</p>","PeriodicalId":14681,"journal":{"name":"JNCI Cancer Spectrum","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142604471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Sexual Function and Satisfaction in Young Women with Breast Cancer: A Five-Year Prospective Study. 年轻女性乳腺癌患者的性功能和满意度:一项为期五年的前瞻性研究
IF 3.4 Q2 ONCOLOGY Pub Date : 2024-11-06 DOI: 10.1093/jncics/pkae111
Ana Ferrigno Guajardo, Bryan F Vaca-Cartagena, Fernanda Mesa-Chavez, Alejandra Platas, Alan Fonseca, Marlid Cruz-Ramos, Melina Miaja Avila, Ana Laura Rodriguez, Paula Cabrera-Galeana, Alejandro Mohar, Cynthia Villarreal-Garza

Background: Young women with breast cancer (YWBC) face unique challenges that can impact their sexual health. This study aimed to identify factors associated with sexual activity, function, and satisfaction in YWBC up to five years post-diagnosis.

Methods: We conducted a prospective cohort study of 474 women aged ≤40 years diagnosed with non-metastatic breast cancer in Mexico. Sexual function and satisfaction were assessed using the Female Sexual Function Index and the Sexual Satisfaction Inventory, respectively. Factors associated with sexual health outcomes were examined using mixed-effects models.

Results: The prevalence of sexual dysfunction increased from 33.6% at baseline to 52.9% at 4-5 years post-diagnosis. Factors associated with worse sexual function included older age (mean predicted FSFI score -1.35, p = .037), treatment-induced amenorrhea (-2.86, p < .001), depression (-4.11, p < .001), and anxiety (-2.13, p < .001). Lower sexual satisfaction was associated with lower educational attainment (mean predicted SSI score -5.61, p = .002), being single (-6.41, p < .001), treatment induced amenorrhea (-3.76, p = .004), bilateral oophorectomy (-8.21, p = .017), depression (-11.29, p < .001), and anxiety (-7.50, p < .001). Quality of life, body image, and systemic therapy side effects significantly impacted both outcomes. Three distinct trajectories of sexual function were identified: high (62.2%), intermediate (24.3%), and markedly declining (13.5%). Four trajectories of sexual satisfaction were found, ranging from intermediate-to-high (57.3%) to progressively worsening (27.5%).

Conclusion: Sexual dysfunction is prevalent and persistent among YWBC. Multiple biological, psychological, and social factors influence sexual health outcomes in this population. These findings highlight the importance of routine screening and tailored interventions to address the sexual health of YWBC throughout survivorship.

背景:年轻女性乳腺癌患者(YWBC)面临着可能影响其性健康的独特挑战。本研究旨在确定与 YWBC 诊断后五年内的性活动、性功能和性满足相关的因素:我们对墨西哥 474 名年龄小于 40 岁、确诊为非转移性乳腺癌的女性进行了前瞻性队列研究。性功能和满意度分别通过女性性功能指数和性满意度量表进行评估。采用混合效应模型研究了与性健康结果相关的因素:结果:性功能障碍的发生率从基线时的 33.6% 增加到诊断后 4-5 年的 52.9%。与性功能较差相关的因素包括年龄较大(预测的 FSFI 平均得分-1.35,p = .037)、治疗引起的闭经(-2.86,p 结论:性功能障碍在女性同性恋者中普遍存在:性功能障碍在青年妇女和儿童中普遍存在且持续存在。多种生物、心理和社会因素影响着这一人群的性健康结果。这些研究结果强调了常规筛查和有针对性的干预措施对解决女青年在整个生存期的性健康问题的重要性。
{"title":"Sexual Function and Satisfaction in Young Women with Breast Cancer: A Five-Year Prospective Study.","authors":"Ana Ferrigno Guajardo, Bryan F Vaca-Cartagena, Fernanda Mesa-Chavez, Alejandra Platas, Alan Fonseca, Marlid Cruz-Ramos, Melina Miaja Avila, Ana Laura Rodriguez, Paula Cabrera-Galeana, Alejandro Mohar, Cynthia Villarreal-Garza","doi":"10.1093/jncics/pkae111","DOIUrl":"https://doi.org/10.1093/jncics/pkae111","url":null,"abstract":"<p><strong>Background: </strong>Young women with breast cancer (YWBC) face unique challenges that can impact their sexual health. This study aimed to identify factors associated with sexual activity, function, and satisfaction in YWBC up to five years post-diagnosis.</p><p><strong>Methods: </strong>We conducted a prospective cohort study of 474 women aged ≤40 years diagnosed with non-metastatic breast cancer in Mexico. Sexual function and satisfaction were assessed using the Female Sexual Function Index and the Sexual Satisfaction Inventory, respectively. Factors associated with sexual health outcomes were examined using mixed-effects models.</p><p><strong>Results: </strong>The prevalence of sexual dysfunction increased from 33.6% at baseline to 52.9% at 4-5 years post-diagnosis. Factors associated with worse sexual function included older age (mean predicted FSFI score -1.35, p = .037), treatment-induced amenorrhea (-2.86, p < .001), depression (-4.11, p < .001), and anxiety (-2.13, p < .001). Lower sexual satisfaction was associated with lower educational attainment (mean predicted SSI score -5.61, p = .002), being single (-6.41, p < .001), treatment induced amenorrhea (-3.76, p = .004), bilateral oophorectomy (-8.21, p = .017), depression (-11.29, p < .001), and anxiety (-7.50, p < .001). Quality of life, body image, and systemic therapy side effects significantly impacted both outcomes. Three distinct trajectories of sexual function were identified: high (62.2%), intermediate (24.3%), and markedly declining (13.5%). Four trajectories of sexual satisfaction were found, ranging from intermediate-to-high (57.3%) to progressively worsening (27.5%).</p><p><strong>Conclusion: </strong>Sexual dysfunction is prevalent and persistent among YWBC. Multiple biological, psychological, and social factors influence sexual health outcomes in this population. These findings highlight the importance of routine screening and tailored interventions to address the sexual health of YWBC throughout survivorship.</p>","PeriodicalId":14681,"journal":{"name":"JNCI Cancer Spectrum","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142589717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
County-level racial disparities in prostate cancer specific mortality from 2005 to 2020. 2005 年至 2020 年前列腺癌特定死亡率的县级种族差异。
IF 3.4 Q2 ONCOLOGY Pub Date : 2024-11-04 DOI: 10.1093/jncics/pkae109
Samuel L Washington, Mary Fakunle, Lufan Wang, Avery E Braun, Michael Leapman, Janet E Cowan, Matthew R Cooperberg

Background: Local conditions where people live continue to influence prostate cancer outcomes. By examining local characteristics associated with trends in Black-White differences in prostate cancer specific mortality (PCSM) over time, we aim to identify factors driving county-level PCSM disparities over a 15-year period.

Methods: We linked county-level data (Area Health Resource File) with clinicodemographic data of men with prostate cancer (Surveillance, Epidemiology, and End Results registry) from 2005 to 2020. Generalized linear mixed models evaluated associations between race and county-level age-standardized PCSM, adjusting for age, year of death, rurality, and county-level education, income, uninsured rates, and densities of urologists, radiologists, primary care providers, and hospital beds.

Results: 185,390 patients in 1085 counties were identified, of which 15.8% were non-Hispanic Black. Racial disparities in PCSM narrowed from 2005 to 2020 (25.4 per 100,000 to 19.2 per 100,000 overall; 57.9 per 100,000 to 38 per 100,000 for Non-Hispanic Black patients and 23.4 per 100,000 to 18.3 per 100,000 for Non-Hispanic White patients). For both Non-Hispanic Black and Non-Hispanic White patients, county PCSM changes varied greatly (-65% to + 77% and -61% to + 112%, respectively). From 2016 to 2020, Non-Hispanic Black harbored greater PCSM risk (RR 2.09, 95% CI 2.01-2.18); higher radiation oncologist density was significantly associated with lower mortality risk (RR 0.93, 95% CI 0.89-0.98) while other provider densities were not.

Conclusion: Although overall rates improved, specific counties experienced worsening race-based disparities over time. Identifying locations of highest (and lowest) mortality disparities remains critical to development of location-specific solutions to racial disparities in prostate cancer outcomes.

背景:人们生活的当地条件继续影响着前列腺癌的治疗效果。通过研究与黑人-白人前列腺癌特异性死亡率(PCSM)随时间变化的趋势相关的地方特征,我们旨在确定在 15 年间造成县级 PCSM 差异的因素:我们将 2005 年至 2020 年的县级数据(地区卫生资源档案)与前列腺癌男性患者的门诊人口学数据(监测、流行病学和最终结果登记)联系起来。广义线性混合模型评估了种族与县级年龄标准化 PCSM 之间的关系,并调整了年龄、死亡年份、乡村、县级教育、收入、无保险率以及泌尿科医生、放射科医生、初级保健提供者和医院床位的密度:结果:确定了 1085 个县的 185,390 名患者,其中 15.8% 为非西班牙裔黑人。从 2005 年到 2020 年,PCSM 的种族差异有所缩小(总体从每 10 万人 25.4 例降至每 10 万人 19.2 例;非西班牙裔黑人患者从每 10 万人 57.9 例降至每 10 万人 38 例;非西班牙裔白人患者从每 10 万人 23.4 例降至每 10 万人 18.3 例)。对于非西班牙裔黑人和非西班牙裔白人患者而言,县级 PCSM 变化差异很大(分别为 -65% 至 + 77% 和 -61% 至 + 112%)。从2016年到2020年,非西班牙裔黑人的PCSM风险更高(RR 2.09,95% CI 2.01-2.18);放射肿瘤学家密度越高,死亡率风险越低(RR 0.93,95% CI 0.89-0.98),而其他医疗机构密度则不然:结论:尽管总体死亡率有所提高,但随着时间的推移,特定县域的种族差异在不断恶化。确定死亡率差异最高(和最低)的地区对于制定针对特定地区的前列腺癌种族差异解决方案至关重要。
{"title":"County-level racial disparities in prostate cancer specific mortality from 2005 to 2020.","authors":"Samuel L Washington, Mary Fakunle, Lufan Wang, Avery E Braun, Michael Leapman, Janet E Cowan, Matthew R Cooperberg","doi":"10.1093/jncics/pkae109","DOIUrl":"https://doi.org/10.1093/jncics/pkae109","url":null,"abstract":"<p><strong>Background: </strong>Local conditions where people live continue to influence prostate cancer outcomes. By examining local characteristics associated with trends in Black-White differences in prostate cancer specific mortality (PCSM) over time, we aim to identify factors driving county-level PCSM disparities over a 15-year period.</p><p><strong>Methods: </strong>We linked county-level data (Area Health Resource File) with clinicodemographic data of men with prostate cancer (Surveillance, Epidemiology, and End Results registry) from 2005 to 2020. Generalized linear mixed models evaluated associations between race and county-level age-standardized PCSM, adjusting for age, year of death, rurality, and county-level education, income, uninsured rates, and densities of urologists, radiologists, primary care providers, and hospital beds.</p><p><strong>Results: </strong>185,390 patients in 1085 counties were identified, of which 15.8% were non-Hispanic Black. Racial disparities in PCSM narrowed from 2005 to 2020 (25.4 per 100,000 to 19.2 per 100,000 overall; 57.9 per 100,000 to 38 per 100,000 for Non-Hispanic Black patients and 23.4 per 100,000 to 18.3 per 100,000 for Non-Hispanic White patients). For both Non-Hispanic Black and Non-Hispanic White patients, county PCSM changes varied greatly (-65% to + 77% and -61% to + 112%, respectively). From 2016 to 2020, Non-Hispanic Black harbored greater PCSM risk (RR 2.09, 95% CI 2.01-2.18); higher radiation oncologist density was significantly associated with lower mortality risk (RR 0.93, 95% CI 0.89-0.98) while other provider densities were not.</p><p><strong>Conclusion: </strong>Although overall rates improved, specific counties experienced worsening race-based disparities over time. Identifying locations of highest (and lowest) mortality disparities remains critical to development of location-specific solutions to racial disparities in prostate cancer outcomes.</p>","PeriodicalId":14681,"journal":{"name":"JNCI Cancer Spectrum","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142568662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Trends in age and prostate-specific antigen at prostate cancer diagnosis between 2010 and 2019. 2010 年至 2019 年诊断前列腺癌时的年龄和前列腺特异性抗原趋势。
IF 3.4 Q2 ONCOLOGY Pub Date : 2024-11-01 DOI: 10.1093/jncics/pkae106
Lukas Owens, Ojas Brahme, Roman Gulati, Ruth Etzioni

Recent studies have shown that de novo metastatic prostate cancer incidence in the United States increased from 2010 to 2019. Plausible explanations include delayed detection after recommendations against prostate cancer screening or upstaging associated with use of more sensitive imaging technologies. Using Surveillance, Epidemiology, and End Results patient cases and controlling for aging of the population, we found the median age and prostate-specific antigen (PSA) level at prostate cancer diagnosis increased by 1.4 years of age (95% CI = 1.3 to 1.5 years) and 1.4 ng/mL (95% CI = 1.4 to 1.5 ng/mL) over this period, consistent with the delayed detection hypothesis. Racial differences were noted, with 75th percentiles of PSA at diagnosis increasing by 4.3 ng/mL (95% CI = 3.7 to 4.8 ng/mL) over this time period for non-Hispanic Black men compared with 3.0 ng/mL (95% CI = 2.8 to 3.2 ng/mL) for non-Hispanic White men. Overall, patient characteristics at diagnosis suggest that delayed detection contributed at least in part to increases in de novo metastatic disease.

最近的研究表明,美国新发转移性前列腺癌的发病率在 2010 年至 2019 年期间有所上升。合理的解释包括:建议不要进行前列腺癌筛查后,发现时间推迟;或使用更敏感的成像技术后,发现时间提前。利用监测、流行病学和最终结果病例并控制人口老龄化,我们发现在此期间,前列腺癌诊断时的中位年龄和前列腺特异性抗原(PSA)水平分别增加了 1.4 岁(95% CI 1.3-1.5)和 1.4 纳克/毫升(95% CI 1.4-1.5),与延迟检测假说一致。在这一时期,非西班牙裔黑人男性诊断时 PSA 的第 75 百分位数增加了 4.3 纳克/毫升(95% CI 3.7-4.8),而非西班牙裔白人男性则为 3.0 纳克/毫升(95% CI 2.8-3.2)。总体而言,诊断时的患者特征表明,延迟检测至少在一定程度上导致了新发转移性疾病的增加。
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引用次数: 0
Posttreatment surveillance intensity and overall survival in prostate cancer survivors (AFT-30). 前列腺癌幸存者的治疗后监测强度和总生存率(AFT-30)。
IF 4.3 Q2 ONCOLOGY Pub Date : 2024-11-01 DOI: 10.1093/jncics/pkae099
Ronald C Chen, Ramsankar Basak, Stacie Dusetzina, Deborah S Usinger, Zahed Mohammed, Aaron D Falchook, Jessica R Schumacher, Amanda B Francescatti, Amanda Cuddy, George J Chang, Benjamin D Kozower, Caprice C Greenberg, Anne K Barber, Aaron J Katz

Background: Posttreatment surveillance affects millions of cancer survivors, but empiric data to guide clinical practice are lacking. This study assessed whether the intensity of surveillance testing after radical prostatectomy or radiation therapy for localized prostate cancer is associated with overall survival.

Methods: Men diagnosed with localized prostate cancer between 2005 and 2010 who underwent radical prostatectomy or radiation therapy at a Commission on Cancer-accredited facility were randomly sampled. Primary data collected from 10 147 patients sampled across 1007 facilities were linked with existing data from the National Cancer Database. Analysis examined whether intensity of surveillance measured as the number of prostate-specific antigen (PSA) tests in the first year after primary treatment (categorized as 0-1 [low intensity], 2 [medium], or ≥3 [high intensity] PSA tests) was associated with overall survival. Secondary outcomes included recurrence-free survival (RFS) and subsequent use of imaging tests, biopsy procedures, and salvage treatment.

Results: Median follow-up exceeded 8 years from prostate cancer diagnosis. Overall survival was not statistically significantly different across surveillance intensity groups among radiation therapy (P = .59) or radical prostatectomy (P = .29) patients. RFS was not statistically significantly different across surveillance intensity groups for radiation therapy (P = .13) patients but was for radical prostatectomy (P = .01) patients with high intensity associated with the worst RFS. In both treatments, higher surveillance intensity was associated with more procedures and salvage treatments.

Conclusions: In patients with localized prostate cancer, more frequent PSA surveillance testing after radical prostatectomy or radiation therapy was associated with increased procedures and salvage treatments but not overall survival.

背景:治疗后监测影响着数百万癌症幸存者,但缺乏经验数据来指导临床实践。本研究评估了局部前列腺癌根治性前列腺切除术(RP)或放射治疗(RT)后监测检测的强度是否与总生存率有关:方法:随机抽样 2005 年至 2010 年期间确诊为局部前列腺癌并在癌症委员会认可的医疗机构接受前列腺癌根治术或放疗的男性患者。从 1007 家医疗机构的 10147 名患者中收集的原始数据与国家癌症数据库中的现有数据进行了关联。分析检验了以初级治疗后第一年的 PSA 检测次数(分为 0-1 次(低强度)、2 次(中强度)或≥ 3 次(高强度)PSA 检测)来衡量的监测强度是否与总生存率相关。次要结果包括无复发生存率(RFS)以及随后使用的成像检测、活检程序和挽救治疗:结果:自前列腺癌确诊起,中位随访时间超过 8 年。RT(P = .59)或RP(P = .29)患者的OS在不同监测强度组间无明显统计学差异。RT(P = .13)患者的 RFS 在不同监控强度组间无明显统计学差异,但 RP(P = .01)患者的 RFS 与高监控强度相关,RFS 较差。在两种治疗方法中,较高的监控强度与较多的手术和挽救治疗有关:结论:在局部前列腺癌患者中,根治性前列腺切除术或放射治疗后更频繁地进行 PSA 监测与手术和挽救治疗的增加有关,但与总生存率无关。
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引用次数: 0
Impact of chemotherapy on patients with mismatch repair deficient advanced endometrial carcinomas-a meta-analysis. 化疗对错配修复缺陷晚期子宫内膜癌患者的影响--一项荟萃分析。
IF 3.4 Q2 ONCOLOGY Pub Date : 2024-11-01 DOI: 10.1093/jncics/pkae101
Angelina Tjokrowidjaja, Peey-Sei Kok, Yoland C Antill, Clare L Scott, Linda R Mileshkin, Michael L Friedlander, Chee K Lee

Background: Chemo-immunotherapy is standard of care for women with recurrent or advanced mismatch repair deficient endometrial carcinoma. However, it is uncertain whether patients with mismatch repair deficient advanced or recurrent endometrial carcinoma derive less benefit from chemotherapy than those with mismatch repair proficient endometrial carcinoma.

Methods: We performed a meta-analysis of randomized controlled trials (RCTs) in advanced or recurrent endometrial carcinoma to determine the difference in the benefit of chemotherapy in mismatch repair deficient vs mismatch repair proficient endometrial carcinoma. Data on chemotherapy outcomes including objective response rate, progression-free survival (PFS), and overall survival were retrieved. We pooled these data using the inverse variance method and examined subgroup difference by mismatch repair status. We also compared differences in PFS and overall survival outcomes by creating individual patient data from the Kaplan-Meier curves of trial publications for sensitivity analyses.

Results: A total of 5 RCTs with 1137 participants (mismatch repair deficient, 26%; mismatch repair proficient, 74%) were included. All participants were treated with carboplatin-based chemotherapy. There was no difference between the mismatch repair deficient and mismatch repair proficient subgroups for objective response rate (66.5% vs 64.0%; P = .20 for subgroup difference), PFS (hazard ratio [HR] = 0.93, 95% confidence interval [CI] = 0.77 to 1.12; P = .44; median PFS = 7.6 vs 9.5 months) or overall survival (HR = 1.03, 95% CI = 0.73 to 1.44; P = .88; median overall survival = not reached vs 28.6 months).

Conclusions: Objective response rate, PFS, and overall survival were similar among those with mismatch repair deficient vs mismatch repair proficient endometrial cancer treated with front-line, platinum-doublet chemotherapy in RCTs. These findings reinforce the importance of combining chemotherapy together with immune checkpoint inhibitors until the results of trials comparing immune checkpoint therapy alone with combination therapy are available.

简介:化疗免疫疗法是治疗复发或晚期错配修复缺陷(dMMR)子宫内膜癌(EC)妇女的标准疗法。然而,目前还不确定dMMR晚期或复发性子宫内膜癌患者从化疗中获得的益处是否少于错配修复熟练型(pMMR)子宫内膜癌患者:我们对晚期/复发性EC的随机对照试验(RCT)进行了荟萃分析,以确定dMMR与pMMR EC化疗获益的差异。我们检索了化疗结果数据,包括客观反应率(ORR)、无进展生存期(PFS)和总生存期(OS)。我们使用逆方差法汇总了这些数据,并根据 MMR 状态研究了亚组差异。我们还通过从试验出版物的 Kaplan-Meier 曲线中创建单个患者数据来比较 PFS 和 OS 结果的差异,以进行敏感性分析:共纳入了 5 项 RCT,1137 名参与者(dMMR,26%;pMMR,74%)。所有参与者均接受了以卡铂为基础的化疗。dMMR亚组和pMMR亚组在ORR(66.5% vs 64.0%,亚组差异P = .20)、PFS(HR 0.93,95% CI 0.77-1.12,P = .44;中位PFS 7.6 vs 9.5个月)或OS(HR 1.03,95% CI 0.73-1.44,P = .88;未达到中位OS vs 28.6个月)方面没有差异:结论:在随机临床试验中,dMMR与pMMR子宫内膜癌患者接受一线铂双药化疗的ORR、PFS和OS相似。这些发现加强了化疗与免疫检查点抑制剂联合治疗的重要性,直到将免疫检查点疗法单独与联合疗法进行比较的试验结果出来为止。
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引用次数: 0
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JNCI Cancer Spectrum
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