Pub Date : 2024-10-28DOI: 10.1007/s10552-024-01921-0
Joanna Woersching, Janet H Van Cleave, Jason P Gonsky, Chenjuan Ma, Judith Haber, Deborah Chyun, Brian L Egleston
Purpose: Mental health disorders, substance abuse, and tobacco use are prevalent in the US population. However, the association between these conditions and head and neck cancer (HNC) stage is poorly understood. This research aims to uncover the relationship between pre-existing mental health disorders, substance abuse, and tobacco use and HNC stage at diagnosis in patients receiving care in an integrated, public safety-net healthcare system.
Methods: This study was a secondary data analysis of linked hospital tumor registries and electronic health record (EHR) data. The study's primary independent variables were the comorbidities of mental health disorders, substance abuse, and tobacco use. The dependent variable was HNC stage at diagnosis, operationalized as early stage (i.e., stages I, II, and III) and advanced stage (stage IV, IVA, IVB, or IVC). The analysis included multivariable logistic regression adjusted for covariates of demographic variables, tumor anato RESULTS: The study population consisted of 357 patients with median age of 59 years, and was primarily male (77%), diverse (Black or African American 41%; Hispanic 22%), and from neighborhoods with low income (median average annual household income $39,785). Patients with a history of mental health disorders with or without tobacco use had significantly lower odds of advanced stage HNC at diagnosis (adjusted OR = 0.35, 95% Confidence Interval [CI]: 0.17-0.72.) while patients with a history of substance abuse with or without tobacco use had significantly higher odds of advanced stage HNC at diagnosis (adjusted OR 1.41, 95% CI: 1.01-1.98) than patients with no history of mental health disorders, substance abuse, or tobacco use.
Conclusions: The relationship between HNC stage at diagnosis and the comorbidities of mental health disorders, substance abuse, or tobacco differs depending on the type and co-occurrence of these comorbidities. These findings demonstrate the need for innovative care delivery models and education initiatives tailored to meet the needs of patients with mental health disorders, substance abuse, and tobacco use that facilitate early detection of HNC.
{"title":"The association between the mental health disorders, substance abuse, and tobacco use with head & neck cancer stage at diagnosis.","authors":"Joanna Woersching, Janet H Van Cleave, Jason P Gonsky, Chenjuan Ma, Judith Haber, Deborah Chyun, Brian L Egleston","doi":"10.1007/s10552-024-01921-0","DOIUrl":"https://doi.org/10.1007/s10552-024-01921-0","url":null,"abstract":"<p><strong>Purpose: </strong>Mental health disorders, substance abuse, and tobacco use are prevalent in the US population. However, the association between these conditions and head and neck cancer (HNC) stage is poorly understood. This research aims to uncover the relationship between pre-existing mental health disorders, substance abuse, and tobacco use and HNC stage at diagnosis in patients receiving care in an integrated, public safety-net healthcare system.</p><p><strong>Methods: </strong>This study was a secondary data analysis of linked hospital tumor registries and electronic health record (EHR) data. The study's primary independent variables were the comorbidities of mental health disorders, substance abuse, and tobacco use. The dependent variable was HNC stage at diagnosis, operationalized as early stage (i.e., stages I, II, and III) and advanced stage (stage IV, IVA, IVB, or IVC). The analysis included multivariable logistic regression adjusted for covariates of demographic variables, tumor anato RESULTS: The study population consisted of 357 patients with median age of 59 years, and was primarily male (77%), diverse (Black or African American 41%; Hispanic 22%), and from neighborhoods with low income (median average annual household income $39,785). Patients with a history of mental health disorders with or without tobacco use had significantly lower odds of advanced stage HNC at diagnosis (adjusted OR = 0.35, 95% Confidence Interval [CI]: 0.17-0.72.) while patients with a history of substance abuse with or without tobacco use had significantly higher odds of advanced stage HNC at diagnosis (adjusted OR 1.41, 95% CI: 1.01-1.98) than patients with no history of mental health disorders, substance abuse, or tobacco use.</p><p><strong>Conclusions: </strong>The relationship between HNC stage at diagnosis and the comorbidities of mental health disorders, substance abuse, or tobacco differs depending on the type and co-occurrence of these comorbidities. These findings demonstrate the need for innovative care delivery models and education initiatives tailored to meet the needs of patients with mental health disorders, substance abuse, and tobacco use that facilitate early detection of HNC.</p>","PeriodicalId":9432,"journal":{"name":"Cancer Causes & Control","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142495663","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-27DOI: 10.1007/s10552-024-01930-z
Dagfinn Aune, Marie Nordsletten, Tor Åge Myklebust, Trude Eid Robsahm, Bjørn Steen Skålhegg, Tom Mala, Sheraz Yaqub, Usman Saeed
Background: There is limited evidence of potential associations between body mass index (BMI) and risk of vulvar and vaginal cancer. We explored these associations in a large cohort of Norwegian women.
Methods: The analytical dataset included 889,441 women aged 16-75 years at baseline in 1963-1975. Multivariable Cox regression analyses were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the associations between BMI and vulvar and vaginal cancer incidence.
Results: During 30.1 million person-years of follow-up, 1748 incident vulvar and 408 incident vaginal cancer cases occurred. The HRs (95% CIs) for vulvar cancer for a BMI of 15- < 18.5, 18.5- < 25, 25- < 30, 30- < 35, ≥ 35 were 0.62 (0.38-1.01), 1.00 (reference), 1.23 (1.10-1.40), 1.43 (1.23-1.66) and 1.72 (1.35-2.20, ptrend < 0.001), and per 5 kg/m2 increment was 1.20 (1.13-1.26). The corresponding HRs (95% CIs) for vaginal cancer were 1.05 (0.52-2.15), 1.00, 0.89 (0.71-1.12), 0.95 (0.68-1.34), and 2.01 (1.29-3.13, ptrend < 0.001), respectively, and per 5 kg/m2 was 1.11 (0.99-1.25). The HR (95% CI) per 5 kg/m2 increase in BMI at ages 16-29 was 1.28 (1.07-1.54, n = 250 cases) for vulvar and 1.53 (1.11-2.11, n = 66 cases) for vaginal cancers. The HR (95% CI) per 5 kg/m2 for early-onset (< 50 years age at diagnosis) vulvar cancer was 0.92 (0.66-1.28, n = 87 cases) and 1.70 (1.05-2.76, n = 21 cases) for vaginal cancer.
Conclusion: These results further support the associations between higher BMI and increased risk of vulvar and vaginal cancers, with suggestive stronger associations between BMI in early adulthood for both cancers and for early-onset vaginal cancer. Further studies are needed to elucidate these findings and investigate the underlying mechanisms.
{"title":"The association between body mass index and vulvar and vaginal cancer incidence: findings from a large Norwegian cohort study.","authors":"Dagfinn Aune, Marie Nordsletten, Tor Åge Myklebust, Trude Eid Robsahm, Bjørn Steen Skålhegg, Tom Mala, Sheraz Yaqub, Usman Saeed","doi":"10.1007/s10552-024-01930-z","DOIUrl":"https://doi.org/10.1007/s10552-024-01930-z","url":null,"abstract":"<p><strong>Background: </strong>There is limited evidence of potential associations between body mass index (BMI) and risk of vulvar and vaginal cancer. We explored these associations in a large cohort of Norwegian women.</p><p><strong>Methods: </strong>The analytical dataset included 889,441 women aged 16-75 years at baseline in 1963-1975. Multivariable Cox regression analyses were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the associations between BMI and vulvar and vaginal cancer incidence.</p><p><strong>Results: </strong>During 30.1 million person-years of follow-up, 1748 incident vulvar and 408 incident vaginal cancer cases occurred. The HRs (95% CIs) for vulvar cancer for a BMI of 15- < 18.5, 18.5- < 25, 25- < 30, 30- < 35, ≥ 35 were 0.62 (0.38-1.01), 1.00 (reference), 1.23 (1.10-1.40), 1.43 (1.23-1.66) and 1.72 (1.35-2.20, p<sub>trend</sub> < 0.001), and per 5 kg/m<sup>2</sup> increment was 1.20 (1.13-1.26). The corresponding HRs (95% CIs) for vaginal cancer were 1.05 (0.52-2.15), 1.00, 0.89 (0.71-1.12), 0.95 (0.68-1.34), and 2.01 (1.29-3.13, p<sub>trend</sub> < 0.001), respectively, and per 5 kg/m<sup>2</sup> was 1.11 (0.99-1.25). The HR (95% CI) per 5 kg/m<sup>2</sup> increase in BMI at ages 16-29 was 1.28 (1.07-1.54, n = 250 cases) for vulvar and 1.53 (1.11-2.11, n = 66 cases) for vaginal cancers. The HR (95% CI) per 5 kg/m<sup>2</sup> for early-onset (< 50 years age at diagnosis) vulvar cancer was 0.92 (0.66-1.28, n = 87 cases) and 1.70 (1.05-2.76, n = 21 cases) for vaginal cancer.</p><p><strong>Conclusion: </strong>These results further support the associations between higher BMI and increased risk of vulvar and vaginal cancers, with suggestive stronger associations between BMI in early adulthood for both cancers and for early-onset vaginal cancer. Further studies are needed to elucidate these findings and investigate the underlying mechanisms.</p>","PeriodicalId":9432,"journal":{"name":"Cancer Causes & Control","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142495662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-24DOI: 10.1007/s10552-024-01927-8
Ashley E Stenzel, G Nic Rider, Olivia S Wicker, Allison C Dona, Deanna Teoh, B R Simon Rosser, Rachel I Vogel
Purpose: Lesbian, gay, bisexual, transgender, queer, and other sexual and gender diverse (LGBTQ+) individuals experience disparities in cancer screening. We examined whether experience of LGBTQ+ -related discrimination in medical settings was associated with cancer screening disparities.
Methods: Participants were recruited via social media for a cross-sectional survey study. Those who self-reported as LGBTQ+ , being 40+ years of age, and residing in the US were eligible. Participants reported their clinical and demographic characteristics, cancer screening history, and experiences of discrimination in a medical setting. We examined the odds (OR) of ever undergoing cancer screening by experienced discrimination, stratified by sex assigned at birth.
Results: Participants (n = 310) were on average 54.4 ± 9.0 years old and primarily White (92.9%). Most identified as lesbian (38.1%) or gay (40.0%) while 17.1% were transgender or gender diverse. Nearly half (45.5%) reported experiencing LGBTQ+ -related discrimination in the medical setting. Participants assigned female at birth with discriminatory experiences had significantly lower odds of ever undergoing colonoscopy/sigmoidoscopy compared to those without discriminatory experiences (OR: 0.37; 95% Confidence Interval (CI) 0.15-0.90). No significant differences in colonoscopy/sigmoidoscopy uptake were observed in those assigned male at birth by discriminatory experiences (OR: 2.02; 95% CI 0.59-6.91). Pap tests, mammogram, and stool colorectal cancer screening did not differ by discriminatory experience.
Conclusion: Discrimination in medical settings was commonly reported by LGBTQ+ individuals in this study. When treating LGBTQ+ patients, clinicians should ask about prior experiences and continue to promote cancer screening. Future studies should examine discrimination as a key driver of LGBTQ+ disparities in cancer screening.
{"title":"Discrimination in the medical setting among LGBTQ+ adults and associations with cancer screening.","authors":"Ashley E Stenzel, G Nic Rider, Olivia S Wicker, Allison C Dona, Deanna Teoh, B R Simon Rosser, Rachel I Vogel","doi":"10.1007/s10552-024-01927-8","DOIUrl":"https://doi.org/10.1007/s10552-024-01927-8","url":null,"abstract":"<p><strong>Purpose: </strong>Lesbian, gay, bisexual, transgender, queer, and other sexual and gender diverse (LGBTQ+) individuals experience disparities in cancer screening. We examined whether experience of LGBTQ+ -related discrimination in medical settings was associated with cancer screening disparities.</p><p><strong>Methods: </strong>Participants were recruited via social media for a cross-sectional survey study. Those who self-reported as LGBTQ+ , being 40+ years of age, and residing in the US were eligible. Participants reported their clinical and demographic characteristics, cancer screening history, and experiences of discrimination in a medical setting. We examined the odds (OR) of ever undergoing cancer screening by experienced discrimination, stratified by sex assigned at birth.</p><p><strong>Results: </strong>Participants (n = 310) were on average 54.4 ± 9.0 years old and primarily White (92.9%). Most identified as lesbian (38.1%) or gay (40.0%) while 17.1% were transgender or gender diverse. Nearly half (45.5%) reported experiencing LGBTQ+ -related discrimination in the medical setting. Participants assigned female at birth with discriminatory experiences had significantly lower odds of ever undergoing colonoscopy/sigmoidoscopy compared to those without discriminatory experiences (OR: 0.37; 95% Confidence Interval (CI) 0.15-0.90). No significant differences in colonoscopy/sigmoidoscopy uptake were observed in those assigned male at birth by discriminatory experiences (OR: 2.02; 95% CI 0.59-6.91). Pap tests, mammogram, and stool colorectal cancer screening did not differ by discriminatory experience.</p><p><strong>Conclusion: </strong>Discrimination in medical settings was commonly reported by LGBTQ+ individuals in this study. When treating LGBTQ+ patients, clinicians should ask about prior experiences and continue to promote cancer screening. Future studies should examine discrimination as a key driver of LGBTQ+ disparities in cancer screening.</p>","PeriodicalId":9432,"journal":{"name":"Cancer Causes & Control","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142495660","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-24DOI: 10.1007/s10552-024-01931-y
Ursula Martinez, Thomas H Brandon, Graham W Warren, Vani N Simmons
Purpose: Smoking after cancer impairs cancer treatment outcomes and prognosis, regardless of cancer type. Prior data suggest that patients with cancers other than lung or head/neck cancer had lower cessation motivation, which in turn predicted lower smoking abstinence. This study evaluated feasibility for a future efficacy trial and assessed the acceptability of brief self-help materials, targeted by cancer type, to enhance cessation motivation.
Methods: Patients had a diagnosis of skin melanoma, breast, bladder, colorectal, or gynecological cancers within ≤ 6 months, smoked ≥ 1 cigarette in the past month, and were not currently participating in a cessation program. After completing a baseline assessment, participants received the booklet corresponding to their cancer type. Follow-ups were conducted 1 week and 1 month post-intervention.
Results: Among 118 patients potentially eligible, 109 were successfully contacted and 53 patients were eligible and all consented. Among consenting patients, 92.5% completed baseline, and 90.6% received the intervention. Among patients receiving the intervention, 91.7% completed all study procedures and follow-up. At 1 month, 87.5% reported reading the booklet and 92.8% rated it as good/excellent. Motivation to quit smoking increased over time among those with lower motivation at baseline, 33.3% sought smoking cessation assistance, and 25.0% were smoke-free 1 month post-intervention.
Conclusion: This study demonstrated the feasibility and acceptability of the first intervention developed for patients with cancers not typically associated with smoking. This low-cost and easy to disseminate intervention has potential to increase motivation to quit smoking among patients with cancers not typically perceived as smoking-related.
{"title":"Motivating smoking cessation among patients with cancers not perceived as smoking-related: a targeted intervention.","authors":"Ursula Martinez, Thomas H Brandon, Graham W Warren, Vani N Simmons","doi":"10.1007/s10552-024-01931-y","DOIUrl":"https://doi.org/10.1007/s10552-024-01931-y","url":null,"abstract":"<p><strong>Purpose: </strong>Smoking after cancer impairs cancer treatment outcomes and prognosis, regardless of cancer type. Prior data suggest that patients with cancers other than lung or head/neck cancer had lower cessation motivation, which in turn predicted lower smoking abstinence. This study evaluated feasibility for a future efficacy trial and assessed the acceptability of brief self-help materials, targeted by cancer type, to enhance cessation motivation.</p><p><strong>Methods: </strong>Patients had a diagnosis of skin melanoma, breast, bladder, colorectal, or gynecological cancers within ≤ 6 months, smoked ≥ 1 cigarette in the past month, and were not currently participating in a cessation program. After completing a baseline assessment, participants received the booklet corresponding to their cancer type. Follow-ups were conducted 1 week and 1 month post-intervention.</p><p><strong>Results: </strong>Among 118 patients potentially eligible, 109 were successfully contacted and 53 patients were eligible and all consented. Among consenting patients, 92.5% completed baseline, and 90.6% received the intervention. Among patients receiving the intervention, 91.7% completed all study procedures and follow-up. At 1 month, 87.5% reported reading the booklet and 92.8% rated it as good/excellent. Motivation to quit smoking increased over time among those with lower motivation at baseline, 33.3% sought smoking cessation assistance, and 25.0% were smoke-free 1 month post-intervention.</p><p><strong>Conclusion: </strong>This study demonstrated the feasibility and acceptability of the first intervention developed for patients with cancers not typically associated with smoking. This low-cost and easy to disseminate intervention has potential to increase motivation to quit smoking among patients with cancers not typically perceived as smoking-related.</p>","PeriodicalId":9432,"journal":{"name":"Cancer Causes & Control","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142495661","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-23DOI: 10.1007/s10552-024-01907-y
Alya Truong, Meg McKinley, Scarlett Lin Gomez, Mi-Ok Kim, Salma Shariff-Marco, Iona Cheng
Purpose: Few studies have examined whether the incidence rates of invasive breast cancer among Asian American, Native Hawaiian, and Pacific Islander (AANHPI) populations differ by the neighborhood social environment. Thus, we examined associations of ethnic enclave and neighborhood socioeconomic status (nSES) with breast cancer incidence rates among AANHPI females in California.
Methods: A total of 14,738 AANHPI females diagnosed with invasive breast cancer in 2008-2012 were identified from the California Cancer Registry. AANHPI ethnic enclaves (culturally distinct neighborhoods) and nSES were assessed at the census tract level using 2007-2011 American Community Survey data. Breast cancer age-adjusted incidence rates and incidence rate ratios (IRRs) were estimated for AANHPI ethnic enclave, nSES, and their joint effects. Subgroup analyses were conducted by stage of disease.
Results: The incidence rate of breast cancer among AANHPI females living in lowest ethnic enclave neighborhoods (quintile (Q)1) were 1.21 times (95% Confidence Interval (CI) 1.11, 1.32) that of AANHPI females living highest ethnic enclave neighborhoods (Q5). In addition, AANHPI females living in highest vs. lowest SES neighborhoods had higher incidence rates of breast cancer (Q5 vs. Q1 IRR = 1.30, 95% CI 1.22 to 1.40). The incidence rate of breast cancer among AANHPI females living in low ethnic enclave + high SES neighborhoods was 1.32 times (95% CI 1.25, 1.39) that of AANHPI females living in high ethnic enclave + low SES neighborhoods. Similar patterns of associations were observed for localized and advanced stage disease.
Conclusion: For AANHPI females in California, incidence rates of breast cancer differed by nSES, ethnic enclave, when considered independently and jointly. Future studies should examine whether the impact of these neighborhood-level factors on breast cancer incidence rates differ across specific AANHPI ethnic groups and investigate the pathways through which they contribute to breast cancer incidence.
{"title":"The role of ethnic enclaves and neighborhood socioeconomic status in invasive breast cancer incidence rates among Asian American, Native Hawaiian, and Pacific Islander females in California.","authors":"Alya Truong, Meg McKinley, Scarlett Lin Gomez, Mi-Ok Kim, Salma Shariff-Marco, Iona Cheng","doi":"10.1007/s10552-024-01907-y","DOIUrl":"https://doi.org/10.1007/s10552-024-01907-y","url":null,"abstract":"<p><strong>Purpose: </strong>Few studies have examined whether the incidence rates of invasive breast cancer among Asian American, Native Hawaiian, and Pacific Islander (AANHPI) populations differ by the neighborhood social environment. Thus, we examined associations of ethnic enclave and neighborhood socioeconomic status (nSES) with breast cancer incidence rates among AANHPI females in California.</p><p><strong>Methods: </strong>A total of 14,738 AANHPI females diagnosed with invasive breast cancer in 2008-2012 were identified from the California Cancer Registry. AANHPI ethnic enclaves (culturally distinct neighborhoods) and nSES were assessed at the census tract level using 2007-2011 American Community Survey data. Breast cancer age-adjusted incidence rates and incidence rate ratios (IRRs) were estimated for AANHPI ethnic enclave, nSES, and their joint effects. Subgroup analyses were conducted by stage of disease.</p><p><strong>Results: </strong>The incidence rate of breast cancer among AANHPI females living in lowest ethnic enclave neighborhoods (quintile (Q)1) were 1.21 times (95% Confidence Interval (CI) 1.11, 1.32) that of AANHPI females living highest ethnic enclave neighborhoods (Q5). In addition, AANHPI females living in highest vs. lowest SES neighborhoods had higher incidence rates of breast cancer (Q5 vs. Q1 IRR = 1.30, 95% CI 1.22 to 1.40). The incidence rate of breast cancer among AANHPI females living in low ethnic enclave + high SES neighborhoods was 1.32 times (95% CI 1.25, 1.39) that of AANHPI females living in high ethnic enclave + low SES neighborhoods. Similar patterns of associations were observed for localized and advanced stage disease.</p><p><strong>Conclusion: </strong>For AANHPI females in California, incidence rates of breast cancer differed by nSES, ethnic enclave, when considered independently and jointly. Future studies should examine whether the impact of these neighborhood-level factors on breast cancer incidence rates differ across specific AANHPI ethnic groups and investigate the pathways through which they contribute to breast cancer incidence.</p>","PeriodicalId":9432,"journal":{"name":"Cancer Causes & Control","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142495664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-18DOI: 10.1007/s10552-024-01913-0
Jordan Baeker Bispo, Hyunjung Lee, Ahmedin Jemal, Farhad Islami
Purpose: Social support has been linked to increased use of preventive care services. Living arrangements and residential stability may be important structural sources of social support, but few studies have examined their impact on cancer screening.
Methods: Data were from the 2021 National Health Interview Survey. Participants were classified as up-to-date or not with female breast cancer (BC), cervical cancer (CVC), and colorectal cancer (CRC) screening recommendations. Multivariable logistic regression was used to model associations between screening and residential stability (< 1 year, 1-3 years, 4-10 years, 11-20 years, or > 20 years), living arrangement (with spouse/partner only, children only, both, or neither), and perceived social support (rarely/never, sometimes, usually, or always available), overall and stratified by sex (CRC) and age group (CVC).
Results: The adjusted odds of BC (odds ratio [OR] 0.61, 95% CI 0.45-0.81) and CVC (OR 0.76, 95% CI 0.60-0.96) screening were lowest for those who reported never/rarely vs. always having social support. The adjusted odds of BC (OR 1.44, 95% CI 1.22-1.70) and CRC (ORFEMALE = 1.42, 95% CI 1.20-1.68; ORMALE = 1.61, 95% CI 1.35-1.90) screening were higher for those living with a spouse/partner only vs. those living with neither spouse/partner nor children. Less residential stability was associated with increased CVC screening among females 21-34 years of age, but not BC or CRC screening.
Conclusions: Social support measures were associated with screening to varying degrees by site and age, but higher perceived social support and living with a spouse/partner only demonstrated a consistent positive association. Interventions that mobilize social support networks and address the unmet social needs of parents/caregivers may improve cancer control.
目的:社会支持与预防保健服务使用率的提高有关。生活安排和居住稳定性可能是社会支持的重要结构性来源,但很少有研究探讨它们对癌症筛查的影响:数据来自 2021 年全国健康访谈调查。参与者被分为是否符合女性乳腺癌(BC)、宫颈癌(CVC)和结直肠癌(CRC)筛查建议。多变量逻辑回归用于模拟筛查与居住稳定性(20 年)、居住安排(仅与配偶/伴侣、仅与子女、两者或两者均无)以及感知到的社会支持(很少/从未、有时、通常或始终可用)之间的关系,并按性别(CRC)和年龄组(CVC)进行分层:报告从未/很少获得社会支持与报告总是获得社会支持的人群接受 BC(几率比 [OR] 0.61,95% CI 0.45-0.81)和 CVC(OR 0.76,95% CI 0.60-0.96)筛查的调整后几率最低。仅与配偶/伴侣居住的人群与既无配偶/伴侣也无子女居住的人群相比,BC(OR 1.44,95% CI 1.22-1.70)和 CRC(ORFEMALE = 1.42,95% CI 1.20-1.68;ORMALE = 1.61,95% CI 1.35-1.90)筛查的调整后几率更高。居住稳定性较低与 21-34 岁女性的 CVC 筛查增加有关,但与 BC 或 CRC 筛查无关:结论:社会支持措施与筛查的相关程度因地点和年龄而异,但较高的社会支持感知和仅与配偶/伴侣同住显示出一致的正相关。动员社会支持网络并解决父母/照顾者未得到满足的社会需求的干预措施可能会改善癌症控制。
{"title":"Associations of social support, living arrangements, and residential stability with cancer screening in the United States.","authors":"Jordan Baeker Bispo, Hyunjung Lee, Ahmedin Jemal, Farhad Islami","doi":"10.1007/s10552-024-01913-0","DOIUrl":"https://doi.org/10.1007/s10552-024-01913-0","url":null,"abstract":"<p><strong>Purpose: </strong>Social support has been linked to increased use of preventive care services. Living arrangements and residential stability may be important structural sources of social support, but few studies have examined their impact on cancer screening.</p><p><strong>Methods: </strong>Data were from the 2021 National Health Interview Survey. Participants were classified as up-to-date or not with female breast cancer (BC), cervical cancer (CVC), and colorectal cancer (CRC) screening recommendations. Multivariable logistic regression was used to model associations between screening and residential stability (< 1 year, 1-3 years, 4-10 years, 11-20 years, or > 20 years), living arrangement (with spouse/partner only, children only, both, or neither), and perceived social support (rarely/never, sometimes, usually, or always available), overall and stratified by sex (CRC) and age group (CVC).</p><p><strong>Results: </strong>The adjusted odds of BC (odds ratio [OR] 0.61, 95% CI 0.45-0.81) and CVC (OR 0.76, 95% CI 0.60-0.96) screening were lowest for those who reported never/rarely vs. always having social support. The adjusted odds of BC (OR 1.44, 95% CI 1.22-1.70) and CRC (OR<sub>FEMALE</sub> = 1.42, 95% CI 1.20-1.68; OR<sub>MALE</sub> = 1.61, 95% CI 1.35-1.90) screening were higher for those living with a spouse/partner only vs. those living with neither spouse/partner nor children. Less residential stability was associated with increased CVC screening among females 21-34 years of age, but not BC or CRC screening.</p><p><strong>Conclusions: </strong>Social support measures were associated with screening to varying degrees by site and age, but higher perceived social support and living with a spouse/partner only demonstrated a consistent positive association. Interventions that mobilize social support networks and address the unmet social needs of parents/caregivers may improve cancer control.</p>","PeriodicalId":9432,"journal":{"name":"Cancer Causes & Control","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142458613","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-18DOI: 10.1007/s10552-024-01926-9
Karen M Tuesley, Penelope M Webb, Melinda M Protani, Peter Donovan, Susan J Jordan, Suzanne Dixon-Suen
Background: Estrogen may play a role in epithelial ovarian cancer (EOC) carcinogenesis, with effects varying by EOC histotype. Measuring women's long-term exposure to estrogen is difficult, but bone mineral density (BMD) may be a reasonable proxy of longer-term exposure. We examined this relationship by assessing the association between genetic predisposition for higher BMD and risk of EOC by histotype.
Methods: We used Mendelian randomization (MR) to assess associations between genetic markers for femoral neck and lumbar spine BMD and each EOC histotype. We used multivariable MR (MVMR) to adjust for probable pleiotropic traits, including body mass index, height, menarcheal age, menopausal age, smoking, alcohol intake, and vitamin D.
Results: Univariable analyses suggested greater BMD was associated with increased risk of endometrioid EOC (per standard deviation increase; lumbar spine OR = 1.21; 95% CI 0.93,1.57, femoral neck: OR = 1.25; 0.99,1.57), but sensitivity analyses indicated that pleiotropy was likely. Adjustment using MVMR reduced the magnitude of estimates slightly (lumbar spine: OR = 1.13; 95% CI 1.00,1.28, femoral neck: OR = 1.18; 1.03,1.36). Results for lumbar spine BMD and high-grade serous EOC were also suggestive of an association (univariable MR: OR = 1.16; 95% CI 1.03,1.30; MVMR: OR = 1.06; 0.99,1.14).
Conclusion: Our study found associations between genetic predisposition to higher BMD, a proxy for long-term estrogen exposure, and risk of developing endometroid and high-grade serous EOC cancers. These findings add to existing evidence of the relationship between estrogen and increased risk of EOC for certain histotypes.
{"title":"Exploring estrogen-related mechanisms in ovarian carcinogenesis: association between bone mineral density and ovarian cancer risk in a multivariable Mendelian randomization study.","authors":"Karen M Tuesley, Penelope M Webb, Melinda M Protani, Peter Donovan, Susan J Jordan, Suzanne Dixon-Suen","doi":"10.1007/s10552-024-01926-9","DOIUrl":"https://doi.org/10.1007/s10552-024-01926-9","url":null,"abstract":"<p><strong>Background: </strong>Estrogen may play a role in epithelial ovarian cancer (EOC) carcinogenesis, with effects varying by EOC histotype. Measuring women's long-term exposure to estrogen is difficult, but bone mineral density (BMD) may be a reasonable proxy of longer-term exposure. We examined this relationship by assessing the association between genetic predisposition for higher BMD and risk of EOC by histotype.</p><p><strong>Methods: </strong>We used Mendelian randomization (MR) to assess associations between genetic markers for femoral neck and lumbar spine BMD and each EOC histotype. We used multivariable MR (MVMR) to adjust for probable pleiotropic traits, including body mass index, height, menarcheal age, menopausal age, smoking, alcohol intake, and vitamin D.</p><p><strong>Results: </strong>Univariable analyses suggested greater BMD was associated with increased risk of endometrioid EOC (per standard deviation increase; lumbar spine OR = 1.21; 95% CI 0.93,1.57, femoral neck: OR = 1.25; 0.99,1.57), but sensitivity analyses indicated that pleiotropy was likely. Adjustment using MVMR reduced the magnitude of estimates slightly (lumbar spine: OR = 1.13; 95% CI 1.00,1.28, femoral neck: OR = 1.18; 1.03,1.36). Results for lumbar spine BMD and high-grade serous EOC were also suggestive of an association (univariable MR: OR = 1.16; 95% CI 1.03,1.30; MVMR: OR = 1.06; 0.99,1.14).</p><p><strong>Conclusion: </strong>Our study found associations between genetic predisposition to higher BMD, a proxy for long-term estrogen exposure, and risk of developing endometroid and high-grade serous EOC cancers. These findings add to existing evidence of the relationship between estrogen and increased risk of EOC for certain histotypes.</p>","PeriodicalId":9432,"journal":{"name":"Cancer Causes & Control","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142458615","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-17DOI: 10.1007/s10552-024-01922-z
Obsie T Baissa, Tomer Ben-Shushan, Ora Paltiel
Purpose: Improving cancer outcomes in Sub-Saharan Africa (SSA) requires effective implementation of evidence-based strategies. This scoping review maps the evidence on lymphoma epidemiology, treatment challenges, and patient pathways in SSA from 2011 to 2022.
Methods: A comprehensive three-step search was conducted without language restrictions.
Results: Eighty-four publications were included, 83% published after 2017. Southern and Eastern Africa led in output. Most studies were chart reviews (47.6%) and cohort studies (25%). NHL accounted for over 80% of cases, with an age-standardized rate (ASR) reaching 10.9/100,000, while HL had an ASR of 0.4-2.3/100,000. Compared to studies in Europe and US, SSA studies reported lower incidence rates, higher HIV comorbidity, and younger median ages. Diagnosis is often delayed, incomplete and lacks sub-classification with HIV and tuberculosis further complicating care. One-year survival rates are around 50% for NHL and over 75% for HL. Treatment is well-tolerated with an acceptable treatment-related mortality rate. However, outcomes are affected by diagnostic delays, late presentations, and treatment abandonment. Non-clinical aspects of care such as financial constraints negatively impact patient pathways.
Conclusion: Addressing diagnostic delays, misdiagnosis, and treatment abandonment is crucial. Strengthening care access, diagnostics, and integrating innovative strategies including a multidisciplinary approach and re-designing efficient clinical diagnostic pathways are vital.
{"title":"Lymphoma in Sub-Saharan Africa: a scoping review of the epidemiology, treatment challenges, and patient pathways.","authors":"Obsie T Baissa, Tomer Ben-Shushan, Ora Paltiel","doi":"10.1007/s10552-024-01922-z","DOIUrl":"https://doi.org/10.1007/s10552-024-01922-z","url":null,"abstract":"<p><strong>Purpose: </strong>Improving cancer outcomes in Sub-Saharan Africa (SSA) requires effective implementation of evidence-based strategies. This scoping review maps the evidence on lymphoma epidemiology, treatment challenges, and patient pathways in SSA from 2011 to 2022.</p><p><strong>Methods: </strong>A comprehensive three-step search was conducted without language restrictions.</p><p><strong>Results: </strong>Eighty-four publications were included, 83% published after 2017. Southern and Eastern Africa led in output. Most studies were chart reviews (47.6%) and cohort studies (25%). NHL accounted for over 80% of cases, with an age-standardized rate (ASR) reaching 10.9/100,000, while HL had an ASR of 0.4-2.3/100,000. Compared to studies in Europe and US, SSA studies reported lower incidence rates, higher HIV comorbidity, and younger median ages. Diagnosis is often delayed, incomplete and lacks sub-classification with HIV and tuberculosis further complicating care. One-year survival rates are around 50% for NHL and over 75% for HL. Treatment is well-tolerated with an acceptable treatment-related mortality rate. However, outcomes are affected by diagnostic delays, late presentations, and treatment abandonment. Non-clinical aspects of care such as financial constraints negatively impact patient pathways.</p><p><strong>Conclusion: </strong>Addressing diagnostic delays, misdiagnosis, and treatment abandonment is crucial. Strengthening care access, diagnostics, and integrating innovative strategies including a multidisciplinary approach and re-designing efficient clinical diagnostic pathways are vital.</p>","PeriodicalId":9432,"journal":{"name":"Cancer Causes & Control","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142458616","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-15DOI: 10.1007/s10552-024-01929-6
Soumya J Niranjan, Desiree Rivers, Rekha Ramachandran, JEdward Murrell, Kayleigh C Curry, Mohammed Mubasher, Eric Flenaugh, Mark T Dransfield, Sejong Bae, Isabel C Scarinci
Purpose: Low-dose computed tomography lung cancer screening is effective for reducing lung cancer mortality. It is critical to understand the lung cancer screening practices for screen-eligible individuals living in Alabama and Georgia where lung cancer is the leading cause of cancer death. High lung cancer incidence and mortality rates are attributed to high smoking rates among underserved, low income, and rural populations. Therefore, the purpose of this study is to define sociodemographic and clinical characteristics of patients who were screened for lung cancer at an Academic Medical Center (AMC) in Alabama and a Safety Net Hospital (SNH) in Georgia.
Methods: A retrospective cohort study of screen-eligible patients was constructed using electronic health records between 2015 and 2020 seen at an Academic Medical Center (AMC) and a Safety Net Hospital (SNH) separately. Chi-square tests and Student t tests were used to compare screening uptake across patient demographic and clinical variables. Bivariate and multivariate logistic regressions determined significant predictors of lung cancer screening uptake.
Results: At the AMC, 67,355 were identified as eligible for LCS and 1,129 were screened. In bivariate analyses, there were several differences between those who were screened and those who were not screened. Screening status in the site at Alabama-those with active tobacco use are significantly more likely to be screened than former smokers (OR: 3.208, p < 0.01). For every 10-unit increase in distance, the odds of screening decreased by about 15% (OR: 0.848, p < 0.01). For every 10-year increase in age, the odds of screening decrease by about 30% (OR: 0.704, p < 0.01). Each additional comorbidity increases the odds of screening by about 7.5% (OR: 1.075, p < 0.01). Those with both private and public insurance have much higher odds of screening compared to those with only private insurance (OR: 5.403, p < 0.01). However, those with only public insurance have lower odds of screening compared to those with private insurance (OR: 0.393, p < 0.01). At the SNH-each additional comorbidity increased the odds of screening by about 11.9% (OR: 1.119, p = 0.01). Notably, those with public insurance have significantly higher odds of being screened compared to those with private insurance (OR: 2.566, p < 0.01).
Conclusion: The study provides evidence that LCS has not reached all subgroups and that additional targeted efforts are needed to increase lung cancer screening uptake. Furthermore, disparity was noticed between adults living closer to screening institutions and those who lived farther.
目的:低剂量计算机断层扫描肺癌筛查可有效降低肺癌死亡率。在阿拉巴马州和佐治亚州,肺癌是导致癌症死亡的主要原因,了解符合筛查条件的人的肺癌筛查方法至关重要。肺癌发病率和死亡率高的原因是服务不足、低收入和农村人口吸烟率高。因此,本研究旨在确定在阿拉巴马州学术医学中心(AMC)和佐治亚州安全网医院(SNH)接受肺癌筛查的患者的社会人口学和临床特征:利用2015年至2020年间分别在学术医疗中心(AMC)和安全网医院(SNH)就诊的电子健康记录,对符合筛查条件的患者进行回顾性队列研究。采用卡方检验(Chi-square tests)和学生 t 检验(Student t tests)比较不同患者人口统计学和临床变量的筛查接受率。双变量和多变量逻辑回归确定了肺癌筛查接受率的重要预测因素:在AMC,有67,355人被确定为符合肺癌筛查条件,其中1,129人接受了筛查。在双变量分析中,接受筛查者与未接受筛查者之间存在一些差异。阿拉巴马州筛查点的筛查情况--主动吸烟者接受筛查的几率明显高于曾经吸烟者(OR:3.208,p 结论):该研究提供的证据表明,肺癌筛查并未覆盖所有亚群,因此需要采取更多有针对性的措施来提高肺癌筛查率。此外,研究还发现,居住在离筛查机构较近和较远的成年人之间存在差异。
{"title":"Disparities in lung cancer screening utilization at two health systems in the Southeastern USA.","authors":"Soumya J Niranjan, Desiree Rivers, Rekha Ramachandran, JEdward Murrell, Kayleigh C Curry, Mohammed Mubasher, Eric Flenaugh, Mark T Dransfield, Sejong Bae, Isabel C Scarinci","doi":"10.1007/s10552-024-01929-6","DOIUrl":"https://doi.org/10.1007/s10552-024-01929-6","url":null,"abstract":"<p><strong>Purpose: </strong>Low-dose computed tomography lung cancer screening is effective for reducing lung cancer mortality. It is critical to understand the lung cancer screening practices for screen-eligible individuals living in Alabama and Georgia where lung cancer is the leading cause of cancer death. High lung cancer incidence and mortality rates are attributed to high smoking rates among underserved, low income, and rural populations. Therefore, the purpose of this study is to define sociodemographic and clinical characteristics of patients who were screened for lung cancer at an Academic Medical Center (AMC) in Alabama and a Safety Net Hospital (SNH) in Georgia.</p><p><strong>Methods: </strong>A retrospective cohort study of screen-eligible patients was constructed using electronic health records between 2015 and 2020 seen at an Academic Medical Center (AMC) and a Safety Net Hospital (SNH) separately. Chi-square tests and Student t tests were used to compare screening uptake across patient demographic and clinical variables. Bivariate and multivariate logistic regressions determined significant predictors of lung cancer screening uptake.</p><p><strong>Results: </strong>At the AMC, 67,355 were identified as eligible for LCS and 1,129 were screened. In bivariate analyses, there were several differences between those who were screened and those who were not screened. Screening status in the site at Alabama-those with active tobacco use are significantly more likely to be screened than former smokers (OR: 3.208, p < 0.01). For every 10-unit increase in distance, the odds of screening decreased by about 15% (OR: 0.848, p < 0.01). For every 10-year increase in age, the odds of screening decrease by about 30% (OR: 0.704, p < 0.01). Each additional comorbidity increases the odds of screening by about 7.5% (OR: 1.075, p < 0.01). Those with both private and public insurance have much higher odds of screening compared to those with only private insurance (OR: 5.403, p < 0.01). However, those with only public insurance have lower odds of screening compared to those with private insurance (OR: 0.393, p < 0.01). At the SNH-each additional comorbidity increased the odds of screening by about 11.9% (OR: 1.119, p = 0.01). Notably, those with public insurance have significantly higher odds of being screened compared to those with private insurance (OR: 2.566, p < 0.01).</p><p><strong>Conclusion: </strong>The study provides evidence that LCS has not reached all subgroups and that additional targeted efforts are needed to increase lung cancer screening uptake. Furthermore, disparity was noticed between adults living closer to screening institutions and those who lived farther.</p>","PeriodicalId":9432,"journal":{"name":"Cancer Causes & Control","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142458614","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-10DOI: 10.1007/s10552-024-01924-x
Lauren M Hurwitz, Maeve Bailey-Whyte, Michael A Daneshvar, Cathy D Vocke, Julian Custer, Bríd M Ryan, Stefan Ambs, Peter A Pinto, Emily L Rossi
Purpose: Surgery, an established short-term immunosuppressive event, may spur dissemination of circulating tumor cells and promote the growth of micrometastases. Whether surgical treatment for prostate cancer (i.e., radical prostatectomy) leads to long-term immune changes is unknown.
Methods: We characterized intra-individual changes in circulating immune cell subsets across a six-month period using serial blood samples from prostate cancer patients pre- and post-radical prostatectomy (n = 11), and from a comparison group managed with active surveillance (n = 8). Immune cell subsets for each patient at each time point were deconvoluted using genome-wide methylation data.
Results: There were no statistically significant intra-individual changes in immune cell proportions from pre- to six months post-radical prostatectomy. There were also no intra-individual changes in immune cell proportions in the active surveillance group, and no differences between treatment groups in immune cell changes over time.
Conclusion: We observed no meaningful changes in circulating immune cell subsets six months after radical prostatectomy, suggesting that surgery-induced immune changes may not be long-lasting.
{"title":"Methylation-based immune deconvolution in prostate cancer patients before and after radical prostatectomy.","authors":"Lauren M Hurwitz, Maeve Bailey-Whyte, Michael A Daneshvar, Cathy D Vocke, Julian Custer, Bríd M Ryan, Stefan Ambs, Peter A Pinto, Emily L Rossi","doi":"10.1007/s10552-024-01924-x","DOIUrl":"https://doi.org/10.1007/s10552-024-01924-x","url":null,"abstract":"<p><strong>Purpose: </strong>Surgery, an established short-term immunosuppressive event, may spur dissemination of circulating tumor cells and promote the growth of micrometastases. Whether surgical treatment for prostate cancer (i.e., radical prostatectomy) leads to long-term immune changes is unknown.</p><p><strong>Methods: </strong>We characterized intra-individual changes in circulating immune cell subsets across a six-month period using serial blood samples from prostate cancer patients pre- and post-radical prostatectomy (n = 11), and from a comparison group managed with active surveillance (n = 8). Immune cell subsets for each patient at each time point were deconvoluted using genome-wide methylation data.</p><p><strong>Results: </strong>There were no statistically significant intra-individual changes in immune cell proportions from pre- to six months post-radical prostatectomy. There were also no intra-individual changes in immune cell proportions in the active surveillance group, and no differences between treatment groups in immune cell changes over time.</p><p><strong>Conclusion: </strong>We observed no meaningful changes in circulating immune cell subsets six months after radical prostatectomy, suggesting that surgery-induced immune changes may not be long-lasting.</p>","PeriodicalId":9432,"journal":{"name":"Cancer Causes & Control","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142399488","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}