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Cancer Dec 2021Phase 1 trials are increasingly important in the molecularly driven era of oncology, but few studies have examined phase 1 participation disparities. The authors of this...
BACKGROUND
Phase 1 trials are increasingly important in the molecularly driven era of oncology, but few studies have examined phase 1 participation disparities. The authors of this study investigated factors associated with phase 1 versus phase 2/3 trial enrollment.
METHODS
They authors conducted a cross-sectional study using serial samples of patients age ≥18 years enrolling on cancer trials from October 2011 to November 2014 at an academic cancer center. They used univariable and multivariable logistic regression models to analyze sociodemographic and clinical associations with phase 1 versus phase 2/3 trial enrollment.
RESULTS
Among 3103 patients enrolled in cancer trials, 2657 unique patients participated in phase 1/2/3 trials. For patients enrolled in phase 1 (n = 1401) versus phase 2/3 (n = 1256) trials, we found no significant differences by age, insurance status, marital status, and income. Overall, 1216 (93%) White, 72 (6%) Asian, and 21 (2%) Black patients enrolled on phase 1 trials, whereas 1068 (93%) White, 40 (3%) Asian, and 43 (4%) Black patients enrolled on phase 2/3 trials. Adjusting for age, sex, race, ethnicity, insurance status, marital status, income, cancer type, disease status, travel distance, and trial year, compared with White patients, Black patients had lower phase 1 enrollment (odds ratio [OR], 0.46; 95% confidence interval [CI], 0.25-0.82), as did Hispanic/Latino (OR, 0.25; 95% CI, 0.08-0.79) and male patients (OR, 0.77; 95% CI, 0.62-0.94). Asian patients had higher phase 1 enrollment (OR, 1.38; 95% CI, 0.88-2.16).
CONCLUSIONS
Disparities in phase 1 versus phase 2/3 cancer clinical trial enrollment underscore the urgent need for interventions addressing inequities in early-phase trial participation.
LAY SUMMARY
Phase 1 trials are of increasing importance in oncology. The authors of the study analyzed all patients enrolling on cancer clinical trials at a large academic cancer center from October 2011 to November 2014. Among the 2657 trial participants, when age, sex, race, ethnicity, insurance status, marital status, income, cancer type, disease status, travel distance, and trial year were taken into account, Black, Hispanic/Latino, and male patients were less likely to enroll on phase 1 trials versus phase 2/3 trials. These findings suggest a need for targeted interventions to improve access to and education about phase 1 trials for Black and Hispanic/Latino patients.
Topics: Adolescent; Black People; Cross-Sectional Studies; Ethnicity; Healthcare Disparities; Humans; Insurance Coverage; Male; Neoplasms
PubMed: 34379799
DOI: 10.1002/cncr.33853 -
Frontiers in Oncology 2022In patients with localized prostate cancer, 5-fraction, stereotactic body radiation therapy (SBRT) has been found to offer comparable oncologic outcomes and potential...
INTRODUCTION AND OBJECTIVES
In patients with localized prostate cancer, 5-fraction, stereotactic body radiation therapy (SBRT) has been found to offer comparable oncologic outcomes and potential for improved treatment compliance compared to conventional, 40-plus fraction radiation therapy (RT). Recent studies of oncologic patient experiences have highlighted both the impact of therapy-associated financial toxicity (FT) on treatment adherence and health-related quality of life (HRQOL).
METHODS
A cross-sectional assessment of FT after SBRT was performed using the 12-item COST questionnaire. The total questionnaire score (range 0-44) was used to evaluate the FT grade (0-3), with a higher COST value representing lower grade. The patient zip code was used to approximate the distance from the index hospital. Univariate and multivariate analyses of the average COST score (0-4) are performed.
RESULTS
The response rate was 57.5% (332 of 575 consented patients) with 90.7%, 8.2%, and 1.1% experiencing grade 0, 1, and 2 FT, respectively, with no grade 3. Unemployment or disability, non-white race, low income, and concurrent hormonal therapy were associated with a statistically significant worse FT (lower COST value) on univariate and multivariate analyses (p < 0.05). Education level and insurance status significant were evaluated on univariate analysis only. There was a non-statistically significant difference in age, marital status, time since treatment, and distance from the index hospital.
CONCLUSIONS
SBRT was associated with low FT. However, statistically significant socioeconomic disparities in FT remain despite ultra-hypofractionated treatment.
PubMed: 35402242
DOI: 10.3389/fonc.2022.852844 -
Journal of Education and Health... 2023In recent studies, the deficit in the cognitive process has been investigated as one of the etiological hypotheses in a wide range of obsessive-compulsive disorders...
Comparison of the effectiveness of acceptance and commitment therapy (ACT) with metacognitive therapy (MCT) in objective cognitive information processing style of obsessive-compulsive patients (OCD).
BACKGROUND
In recent studies, the deficit in the cognitive process has been investigated as one of the etiological hypotheses in a wide range of obsessive-compulsive disorders (OCD). This study aimed to compare the effectiveness of acceptance and commitment therapy (ACT) and metacognitive therapy (MCT) on objective cognitive information processing style in obsessive-compulsive patients.
MATERIALS AND METHODS
This quasi-experimental study with a pre-test and post-test plan and a control group was conducted on 45 patients with OCD, matched with gender, age, and educational and marital status. The samples in three groups were selected using the convenience sampling method. Finally, the study participants were randomly divided into two experimental groups and one control group and assessed using Pacini and Epstein's rational experimental Inventory (REI) in two stages, pre-test, and post-test. The experimental groups received ACT and MCT weekly during eight and seven sessions and in a group.
RESULTS
The results showed that ACT and MCT are effective at a significant level in the objective cognitive information processing style of obsessive-compulsive patients ( < 0.05). The post-test results showed that the effect of ACT in changing rational processing style is more effective than MCT treatment. Also, the effect of ACT on intuitive processing style changes was greater than on MCT treatment.
CONCLUSION
The findings of this study indicate that ACT and MCT cause a significant change in intuitive style to rationalism in the thematic processing of cognitive information of obsessive-compulsive patients. According to the results, both methods of treatment improve the research variables in these patients.
PubMed: 38144015
DOI: 10.4103/jehp.jehp_40_23 -
Sexuality and intimacy after head and neck cancer treatment: An explorative prospective pilot study.Dental and Medical Problems 2022While sexuality and intimacy are suggested to contribute to quality of life (QoL), it is striking that the sexual problems of head and neck cancer patients have not been...
BACKGROUND
While sexuality and intimacy are suggested to contribute to quality of life (QoL), it is striking that the sexual problems of head and neck cancer patients have not been adequately studied.
OBJECTIVES
Our aim was to prospectively assess the impact of head and neck cancer and its treatment on sexuality and intimacy.
MATERIAL AND METHODS
A questionnaire study with a 6-month follow-up period was conducted at the University Hospitals Leuven, Belgium, using the Maudsley marital questionnaire (MMQ), the sexual adjustment questionnaire (SAQ) and the short sexual functioning scale (SSFS) to prospectively assess the impact of head and neck cancer and its treatment on sexuality and intimacy.
RESULTS
Twelve patients (67%) reported a negative impact on their sexuality and/or intimacy. There were significant declines in marital, sexual and general life satisfaction (p < 0.000) at the 6-month follow-up as compared to baseline. There was a significant increase in frustration after sexual activity (p = 0.031). Sexual desire was also impacted, with a near doubling of patients reporting a decline. The perceived importance of discussing sexual issues with one's physician significantly increased from 7 to 16 patients (p = 0.004).
CONCLUSIONS
Sexual problems are common after head and neck cancer treatment. Using a screening instrument can help to identify patients that need intervention. Discussing sexuality and intimacy issues that patients may face before, during and after treatment can have a positive impact on QoL.
Topics: Head and Neck Neoplasms; Humans; Pilot Projects; Prospective Studies; Quality of Life; Sexual Behavior; Sexuality
PubMed: 36068944
DOI: 10.17219/dmp/148156 -
Journal of Marital and Family Therapy Apr 2021The COVID-19 pandemic has transformed so many aspects of our lives. For psychotherapists, telehealth is likely a permanent part of the future mental health landscape....
The COVID-19 pandemic has transformed so many aspects of our lives. For psychotherapists, telehealth is likely a permanent part of the future mental health landscape. For family therapists using a manualized treatment, this brings unique challenges and creative opportunities. In this article, we describe the adaptation of attachment-based family therapy (ABFT) in the context of telehealth and COVID-19. ABFT is an empirically supported treatment model designed for adolescents and young adults struggling with depression, anxiety, trauma, and suicide. ABFT is a semi-structured, process-oriented, and trauma-informed family therapy model which presents its own unique challenges and benefits in telehealth environments. We present our adaptations based on years of telehealth clinical experience and address how this model supports the impact of COVID-19 on families.
Topics: Adolescent; COVID-19; Couples Therapy; Family Therapy; Female; Humans; Male; Models, Psychological; Object Attachment; Professional-Family Relations; Telerehabilitation; Young Adult
PubMed: 33749898
DOI: 10.1111/jmft.12509 -
Clinical Practice and Epidemiology in... 2021Obsessive-Compulsive Disorder (OCD) is a chronic neuropsychiatric disorder associated with unpleasant thoughts or mental images, making the patient repeat physical or...
BACKGROUND
Obsessive-Compulsive Disorder (OCD) is a chronic neuropsychiatric disorder associated with unpleasant thoughts or mental images, making the patient repeat physical or mental behaviors to relieve discomfort. 40-60% of patients do not respond to Serotonin Reuptake Inhibitors, including fluvoxamine therapy.
INTRODUCTION
The aim of the study is to identify the predictors of fluvoxamine therapy in OCD patients by Bayesian Ordinal Quantile Regression Model.
METHODS
This study was performed on 109 patients with OCD. Three methods, including Bayesian ordinal quantile, probit, and logistic regression models, were applied to identify predictors of response to fluvoxamine. The accuracy and weighted kappa were used to evaluate these models.
RESULTS
Our result showed that rs3780413 (mean=-0.69, sd=0.39) and cleaning dimension (mean=-0.61, sd=0.20) had reverse effects on response to fluvoxamine therapy in Bayesian ordinal probit and logistic regression models. In the 75 quantile regression model, marital status (mean=1.62, sd=0.47) and family history (mean=1.33, sd=0.61) had a direct effect, and cleaning (mean=-1.10, sd=0.37) and somatic (mean=-0.58, sd=0.27) dimensions had reverse effects on response to fluvoxamine therapy.
CONCLUSION
Response to fluvoxamine is a multifactorial problem and can be different in the levels of socio-demographic, genetic, and clinical predictors. Marital status, familial history, cleaning, and somatic dimensions are associated with response to fluvoxamine therapy.
PubMed: 34880926
DOI: 10.2174/1745017902117010151 -
International Journal of Community... Jul 2021Quality of life (QOL) and marital contentment, especially marital satisfaction, are important aspects of life. These items are more important in couples involved in HIV...
BACKGROUND
Quality of life (QOL) and marital contentment, especially marital satisfaction, are important aspects of life. These items are more important in couples involved in HIV due to the present social stigma among this population considering women more vulnerable. The aim of this study was to determine the QOL and marital contentment status among seroconcordant and serodiscordant HIV couples compared to non-HIV ones.
METHODS
In this cross-sectional study, 66 serodiscordant, 74 seroconcordant, and 70 non-HIV couples who referred to Lavan High-risk Behavior Counseling Center, Shiraz during September 2017 and December 2019 were studied. QOL and marital contentment were assessed by World Health Organization Quality of Life-BRIEF (WHOQOL BREF) and ENRICH questionnaire, respectively. Chi-square test for qualitative variables, independent T-test and ANOVA followed by LSD post hoc test for quantitative variables were performed. All statistical analyses were performed using SPSS 19.0, and P<0.05 was set as the significant level.
RESULTS
The score of QOL questionnaire was significantly higher in non-HIV couples than serodiscordant and seroconcordant groups (P<0.001). There was no significant difference among seroconcordant and serodiscordant groups (P=0.99), and infected males vs. females (P=0.13). Non-HIV couples had significantly higher marital contentment in comparison to serodiscordant and seroconcordant groups (P<0.001). No difference was detected among seroconcordant and serodiscordant groups (P=0.81) although more contentment was observed among the males (P=0.01).
CONCLUSION
Our study revealed that QOL and marital contentment were different among non-HIV and HIV infected couples. Besides, marital contentment was higher among males than female's in infected patients.
PubMed: 34222545
DOI: 10.30476/ijcbnm.2021.87420.1430 -
Journal of Medical Internet Research Jun 2021In recent years, robots have been considered a new tech industry that can be used to solve the shortage in human resources in the field of health care. Also,...
BACKGROUND
In recent years, robots have been considered a new tech industry that can be used to solve the shortage in human resources in the field of health care. Also, animal-assisted therapy has been used to provide assistance, companionship, and interaction among the elderly and has been shown to have a positive impact on their emotional and psychological well-being. Both pets and robots can provide dynamic communication and positive interaction patterns. However, preferences for middle-aged and older adults in this regard are not clear.
OBJECTIVE
This study explored the degree of acceptance of robots and pets as partners in later life and to determine the needs and preferences of elderly individuals related to companion robots.
METHODS
A total of 273 middle-aged and older adults aged ≥45 years and living in the community were invited to answer a structured questionnaire after watching a companion robot video. Sociodemographic data, physical health status and activities, experience with technology, eHealth literacy, and acceptance and attitude toward robots and pets were recorded and analyzed using multinomial logistic regression analysis.
RESULTS
Age, level of education, type of dwelling, occupation, retirement status, number of comorbidities, experience with pets, experience using apps, and eHealth literacy were significantly associated with acceptance of robots and pets. Middle-aged and older women preferred robots with an animal-like appearance, while men preferred robots that resembled a human adult. In terms of robot functions, participants preferred a companion robot with dancing, singing, storytelling, or news-reporting functions. Participants' marital status and whether or not they lived alone affected their preference of functions in the companion robot.
CONCLUSIONS
Findings from this study inform the development of social robots with regard to their appearance and functions to address loneliness in later life in fast-aging societies.
Topics: Aged; Aging; Animal Assisted Therapy; Animals; Female; Humans; Male; Middle Aged; Robotics; Surveys and Questionnaires; Taiwan
PubMed: 34347621
DOI: 10.2196/23471 -
Annals of Clinical and Translational... Dec 2022To investigate intercultural neurologists' perception of well-being in patients with amyotrophic lateral sclerosis (ALS) using gastrostomy (PEG), non-invasive, and/or...
OBJECTIVE
To investigate intercultural neurologists' perception of well-being in patients with amyotrophic lateral sclerosis (ALS) using gastrostomy (PEG), non-invasive, and/or invasive ventilation (NIV/IV) and to analyse the determinants and impact on the management of the above medical interventions (MIs).
METHODS
The study was based on anonymous questionnaires addressing the clinical approach and personal attitude towards the use of PEG, NIV and IV in ALS patients completed by 465 neurologists: 228 from Germany and 237 from Poland.
RESULTS
The German and Polish neurologists estimated the quality of life in ALS patients using PEG and NIV as neutral, whilst low in individuals using IV. A regression model revealed an independent influence of palliative care training (PCT) and age on that attitude in the German group. Higher values of estimated patients' depressiveness on PEG, NIV and IV were found amongst the Polish neurologists. Marital status, experience in ALS and being a parent independently influenced the perception of patients' depressiveness in the German, whilst marital status, age and PCT were factors in the Polish group. Amongst German neurologists, a higher perception of patients' depressiveness in individuals using PEG, NIV and IV was linked to the later timing of the MIs discussion. In the Polish group, it was a lower estimation of QoL in patients using PEG.
CONCLUSION
Neurologists' perception of ALS patients' well-being on MIs reflects their demographic status, professional experience and potentially their cultural background. This perception plays an important role in the timing of MIs discussion, possibly influencing the decision-making process.
Topics: Humans; Amyotrophic Lateral Sclerosis; Quality of Life; Surveys and Questionnaires; Neurologists; Gastrostomy
PubMed: 36448241
DOI: 10.1002/acn3.51663 -
Journal of Oncology 2021Recent years, there has been a rapid increase in the incidence of esophageal adenocarcinoma (EAC), while the prognosis for patients diagnosed remains poor and has...
OBJECTIVE
Recent years, there has been a rapid increase in the incidence of esophageal adenocarcinoma (EAC), while the prognosis for patients diagnosed remains poor and has slightly improved.
METHODS
We extracted 6,466 cases with detailed demographical characteristics including age at diagnosis, sex, ethnicity, marital status, and clinical features, involving tumor grade and stage at diagnosis and treatment modalities (radiation therapy, chemotherapy, and surgery) from the Surveillance, Epidemiology, and End Results (SEER) (1975-2017) dataset. They were further randomly divided into the training and validating cohorts. Univariate and multivariate Cox analyses were conducted to determine significant variables for construction of nomogram. The predictive power of the model was then assessed by Harrell concordance index (C-index) and the area under the curve (AUC) of the receiver operating characteristic (ROC) curve.
RESULTS
Multivariate analysis revealed that age, marital status, insurance, tumor grade, TNM stage, surgery, and chemotherapy all showed a significant association with overall survival (OS) and cancer-specific survival (CSS). These characteristics were employed to build a nomogram. Particularly, the discrimination of nomogram for OS and CSS prediction in the training set were excellent (C-index = 0.762, 95% CI: 0.754-0.770 and C-index = 0.774, 95% CI: 0.766-0.782). The AUC of the nomogram for predicting 2- and 5-year OS was 0.834 and 0.853 and CSS was 0.844 and 0.866. Similar results were observed in the internal validation set.
CONCLUSION
We have successfully established a novel nomogram for predicting OS and CSS in EAC patients with good accuracy, which can help clinicians predict the survival of individual patient survival and provide optimal treatment strategies.
PubMed: 34567114
DOI: 10.1155/2021/4138575