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JCO Oncology Practice Jun 2020This study was designed to examine the impact of marital status on racial disparities in esophageal cancer care.
PURPOSE
This study was designed to examine the impact of marital status on racial disparities in esophageal cancer care.
PATIENTS AND METHODS
We performed a secondary analysis of data collected from the state cancer registry maintained by the Michigan Department of Health and Human Services. We identified patients with an esophageal cancer diagnosis between January 1, 2000, and December 31, 2013. χ test and logistics regression were used to analyze 6,809 patients who met our eligibility criteria. Statistical significance was defined as ≤ .05.
RESULTS
Approximately 88.4% of our patients were White and 11.6% were Black. A significantly higher number of White patients were married when compared with Blacks (62.9% 31.8%, respectively; < .0001). There was no significant difference in cancer staging between the 2 groups ( = .0671). Married Blacks had similar rates of esophagectomy, chemotherapy, and radiation as married Whites. Both single groups had lower rates of esophagectomy and chemotherapy than married Whites, but single Blacks were the least likely to undergo esophagectomy. Single patients were more likely to refuse treatment.
CONCLUSION
Marital status differs significantly in Black and White patients with esophageal cancer and may help explain racial disparities in cancer care. Further research is needed to explore reasons for care underutilization in single patients and whether these differences translate into clinical outcomes.
Topics: Black or African American; Esophageal Neoplasms; Humans; Marital Status; Michigan; White People
PubMed: 32369408
DOI: 10.1200/JOP.19.00561 -
Indian Journal of Psychological Medicine 2017India is diverse in culture, with multiple aspects that may not match with the Western societal picture. Hence, it has often been seen that therapists encounter unique...
BACKGROUND
India is diverse in culture, with multiple aspects that may not match with the Western societal picture. Hence, it has often been seen that therapists encounter unique aspects of therapy that is faced during actual practice, which is never written in any textbook or research papers. Substantial information is present through both outcome (efficacy and effectiveness) studies and process research, but it has very little impact of actual Marital and Family Therapy (MFT) practice. This paper throws light into "how" and "what" of family therapy with parents of children/adolescents having psychiatric disorders.
MATERIALS AND METHODS
Focused group discussion was conducted with practicing family therapists and mental health professionals working in Psychiatric Tertiary Hospital (National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India). Qualitative analysis was done to disseminate process issues in therapy.
RESULTS
Aspects that are vital for families having children and adolescent with psychiatric disorders include: Academic decline and loss of parental control as main reasons for seeking help, integration of models is noted to be beneficial, therapeutic alliance, intake sessions, conjoint sessions and individual sessions are important, cultural issues like gender of therapist, their cultural belief model, therapist's cultural competence need to be taken into consideration.
CONCLUSIONS
Challenges and way-outs to overcome these has been mentioned and implications discussed.
PubMed: 28515548
DOI: 10.4103/0253-7176.203122 -
PloS One 2011Recent findings suggest that marital status affects survival in patients with different types of cancer. However, its role in the survival of patients with pancreatic...
BACKGROUND
Recent findings suggest that marital status affects survival in patients with different types of cancer. However, its role in the survival of patients with pancreatic ductal adenocarcinoma is unknown. In this study, we investigated whether there was an association between marital status and overall survival (OS) in patients with pancreatic ductal adenocarcinoma (PDAC).
METHODS
Adult patients diagnosed with PDAC between 1998 and 2003 with known marital statuses were identified from the Surveillance, Epidemiology, and End Results registry of the National Cancer Institute. OS for these patients was plotted using the Kaplan-Meier method. Comparative risks of mortality were evaluated by using univariate and multivariate-adjusted Cox regression models.
RESULTS
Using Kaplan-Meier analysis, we found that the median overall survival of patients was 4 months and 3 months (p<0.001) for married and unmarried patients, respectively. Subgroup analysis on patients with cancer-directed surgery showed that the median survival was 16 months and 13 months (P<0.0005) for married and unmarried groups, respectively. Multivariate analysis adjusting for age, race, sex, stage, year of diagnosis, radiation therapy and cancer-directed surgery showed that patients who were married at the time of diagnosis had a significantly decreased risk of death at both 2 months (15% risk reduction) and 3 years (13% risk reduction) post diagnosis.
CONCLUSIONS
Marital status is an independent prognostic factor of both perioperative and long-term survival in patients with PDAC. This observation may suggest a suboptimally met psychosocial need among PDAC patients that is partially fulfilled by the support system provided by marriage.
Topics: Aged; Carcinoma, Pancreatic Ductal; Female; Humans; Male; Marriage; Middle Aged; Pancreatic Neoplasms; SEER Program; Survival Analysis
PubMed: 21698253
DOI: 10.1371/journal.pone.0021052 -
Psycho-oncology Feb 2019The objective of this study was to test the short-term efficacy of a brief, fully manualized marital communication and interpersonal support intervention for couples... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
The objective of this study was to test the short-term efficacy of a brief, fully manualized marital communication and interpersonal support intervention for couples facing recently diagnosed breast cancer.
METHODS
A total of 322 women diagnosed within 6 months with stages 0 to III breast cancer and their 322 spouse caregivers were enrolled. Spouses in the experimental group received five 30- to 60-minute intervention sessions at 2-week intervals by master's-prepared patient educators; controls received the booklet, "What's Happening to the Woman I Love?" Outcomes were assessed at 3, 6, and 9 months using the linear mixed models within an intent-to-treat analysis.
RESULTS
Compared with controls, at 3 months, spouse caregivers significantly improved on standardized measures of depressed mood, anxiety, cancer-related marital communication, interpersonal support, and self-care. All differences except depressed mood and anxiety were sustained at 9 months. Wives significantly improved at 3 months on marital communication and positive appraisal of spouses' interpersonal support; gains remained significant at 9 months. Compared with controls on chemotherapy, wives in the experimental group additionally improved on depressed mood and tended to improve on anxiety.
CONCLUSIONS
A brief, fully manualized intervention delivered directly to spouse caregivers early in the course of their wives' medical treatment improves caregivers' self-care and behavioral-emotional adjustment and wives' positive view of their spouses' support and communication. The brevity and manualized structure of the intervention argue strongly for its scalability, use in cost-sensitive settings, and its potential dissemination through e-health channels.
Topics: Adult; Aged; Anxiety; Breast Neoplasms; Caregivers; Depression; Female; Humans; Male; Middle Aged; Psychotherapy; Self Care; Self Efficacy; Social Support; Spouses; Treatment Outcome
PubMed: 30549145
DOI: 10.1002/pon.4966 -
World Journal of Surgical Oncology Mar 2023The aims of this study were to establish and validate a nomogram model for predicting the survival of patients with early-onset stage I-II colon cancer (CC). (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
The aims of this study were to establish and validate a nomogram model for predicting the survival of patients with early-onset stage I-II colon cancer (CC).
METHODS
Data of eligible patients enrolled from 2012 to 2015 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Patients were randomly allocated to training and validation groups in a 7:3 ratio. Significant prognostic factors were identified by univariate and multivariate analysis and a nomogram model constructed. The predictive performance of the nomogram was evaluated by the concordance index (C-index), calibration plots, and decision curve analysis.
RESULTS
Our study cohort comprised 3528 early-onset CC patients with stage I-II disease, 2469 of whom were allocated to the training cohort and 1059 to the validation cohort. Race, age, marital status, tumor grade, tumor size, tumor stage (T stage), and chemotherapy were considered the significant predictor by univariate analysis. Race, marital status, and T stage were found to be independent prognostic factors by multivariate analysis. The C-indexes of the nomogram were 0.724 and 0.692 in the training and validation cohorts, respectively. Likewise, the calibration plots showed good agreement regarding the probability of 3- and 5-year observed and nomogram-predicted overall survival in the training group. Decision curve analysis showed that the nomogram model was clinically practical and effective. Moreover, applying the nomogram enabled dividing of the patients into two cohorts with different risk scores. The low-risk group thus created had a better survival than the high-risk group.
CONCLUSIONS
We developed and validated a meaningful prognostic nomogram model for patients with early-onset stage I-II CC that clinicians can use to make better decisions for individual patients.
Topics: Humans; Nomograms; Prognosis; Colonic Neoplasms; Databases, Factual; Multivariate Analysis; SEER Program
PubMed: 36964525
DOI: 10.1186/s12957-023-02988-w -
PloS One 2022Marital status has been proposed as a promising prognostic factor in many malignancies, including non-small-cell lung cancer (NSCLC). However, its prognostic value is...
Marital status has been proposed as a promising prognostic factor in many malignancies, including non-small-cell lung cancer (NSCLC). However, its prognostic value is still unclear for individual non-surgical treatments for stage I NSCLC. This study investigated the prognostic value of marital status in patients with early-stage NSCLC treated with stereotactic body radiotherapy (SBRT). Patients with early-stage NSCLC treated with SBRT between January 2003 and March 2014 at our institute were enrolled, and marital status at the time of SBRT was investigated. Propensity score matching (PSM) was applied to reduce potential selection bias between the married and unmarried groups. Two hundred and forty patients (median age 77 years; 152 married, 87 unmarried) were analyzed. The unmarried included higher proportions of the elderly, women, never smokers, and those with decreased pulmonary function compared to the married. PSM identified 53 matched pairs of married and unmarried patients, with no significant difference in patient background parameters. The 5-year overall survival (OS) was 52.8% and 46.9% in the married and unmarried groups, respectively (P = 0.26). There was no significant difference in NSCLC death or non-NSCLC death between the two groups (P = 0.88 and 0.30, respectively). There was no significant difference in OS between married and unmarried male patients (n = 85, 5-year OS, 52.6% vs. 46.0%; P = 0.42) and between married and unmarried female patients (n = 21, 54.5% vs. 50.0%; P = 0.44). In conclusion, marital status was not associated with OS in patients receiving SBRT for early-stage NSCLC.
Topics: Aged; Carcinoma, Non-Small-Cell Lung; Female; Humans; Lung Neoplasms; Male; Marital Status; Neoplasm Staging; Radiosurgery; Retrospective Studies; Small Cell Lung Carcinoma
PubMed: 35657816
DOI: 10.1371/journal.pone.0269463 -
Fertility and Sterility Apr 2011To assess the relationship between infertility, marital benefit, and coping in a sample of men and women undergoing unsuccessful fertility treatments.
OBJECTIVE
To assess the relationship between infertility, marital benefit, and coping in a sample of men and women undergoing unsuccessful fertility treatments.
DESIGN
Prospective longitudinal cohort design using multilevel modeling.
SETTING
Danish public and private hospitals (n = 5) specializing in treating fertility patients.
PATIENT(S)
Participants were Danish men and women about to start a cycle of medically assisted reproduction treatment who were followed for a 5-year period of unsuccessful treatments.
INTERVENTION(S)
None.
MAIN OUTCOME MEASURE(S)
The Copenhagen Multicenter Psychosocial Infertility research program Coping Strategy Scales and Marital Benefit Measure.
RESULT(S)
Compared with men, a greater percentage of women reported high levels of marital benefit. For active-avoidance coping, there was a significant partner effect by gender interaction. Meaning-based strategies increased between 1 and 5 years for men and women. The use of meaning-based coping had a significant positive actor effect with marital benefit for both men and women.
CONCLUSION(S)
Approximately one-third of participants undergoing unsuccessful fertility treatments reported high marital benefit as a positive consequence of the infertility experience. Partner effects for men and women related to active-avoidance coping may be related to the degree of emotional support that each spouse can offer the other, whereas differences in meaning-based coping indicate a possible timing effect related to gender.
Topics: Adaptation, Psychological; Adult; Cohort Studies; Denmark; Family Conflict; Female; Humans; Infertility; Longitudinal Studies; Male; Marriage; Stress, Psychological; Time Factors; Treatment Failure
PubMed: 21333986
DOI: 10.1016/j.fertnstert.2011.01.125 -
BMC Cancer Aug 2021To develop nomograms for the prediction of the 1-, 3-, and 5-year overall survival (OS) and breast cancer-specific survival (BCSS) for patients with lymph node positive,...
BACKGROUND
To develop nomograms for the prediction of the 1-, 3-, and 5-year overall survival (OS) and breast cancer-specific survival (BCSS) for patients with lymph node positive, luminal A breast cancer.
METHODS
Thirty-nine thousand fifty-one patients from The Surveillance, Epidemiology, and End Results (SEER) database were included in our study and were set into a training group (n = 19,526) and a validation group (n = 19,525). Univariate analysis and Cox proportional hazards analysis were used to select variables and set up nomogram models on the basis of the training group. Kaplan-Meier curves and the log-rank test were adopted in the survival analysis and curves plotting. C-index, calibration plots and ROC curves were used to performed internal and external validation on the training group and validation group.
RESULTS
Following independent factors were included in our nomograms: Age, marital status, grade, ethnic group, T stage, positive lymph nodes numbers, Metastasis, surgery, radiotherapy, chemotherapy. In both the training group and testing group, the calibration plots show that the actual and nomogram-predicted survival probabilities are consistent greatly. The C-index values of the nomograms in the training and validation cohorts were 0.782 and 0.806 for OS and 0.783 and 0.804 for BCSS, respectively. The ROC curves show that our nomograms have good discrimination.
CONCLUSIONS
The nomograms may assist clinicians predict the 1-, 3-, and 5-year OS and BCSS of patients with lymph node positive, luminal A breast cancer.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Breast Neoplasms; Carcinoma, Ductal, Breast; Carcinoma, Lobular; Combined Modality Therapy; Female; Follow-Up Studies; Humans; Lymph Nodes; Marital Status; Middle Aged; Neoplasm Metastasis; Nomograms; Prognosis; ROC Curve; Risk Factors; SEER Program; Survival Rate; Young Adult
PubMed: 34454451
DOI: 10.1186/s12885-021-08642-6 -
International Journal For Equity in... Aug 2014About half a million people in South Africa are deprived of antiretroviral therapy (ART), and there is little systematic knowledge on who they are - e.g. by severity of... (Review)
Review
INTRODUCTION
About half a million people in South Africa are deprived of antiretroviral therapy (ART), and there is little systematic knowledge on who they are - e.g. by severity of disease, sex, or socio-economic status (SES). We performed a systematic review to determine the current quantitative evidence-base on equity in utilization of ART among HIV-infected people in South Africa.
METHOD
We conducted a literature search based on the Cochrane guidelines. A study was included if it compared for different groups of HIV infected people (by sex, age, severity of disease, area of living, SES, marital status, ethnicity, religion and/or sexual orientation (i.e. equity criteria)) the number initiating/adhering to ART with the number who did not. We considered ART utilization inequitable for a certain criterion (e.g. sex) if between groups (e.g. men versus women) significant differences were reported in ART initiation/adherence.
RESULTS
Twelve studies met the inclusion criteria. For sex, 2 out of 10 studies that investigated this criterion found that men are less likely than women to utilize ART, while the other 8 found no differences. For age, 4 out of 8 studies found inequities and reported less utilization for younger people. For area of living, 3 out of 4 studies showed that those living in rural areas or certain provinces have less access and 2 out of 6 studies looking at SES found that people with lower SES have less access. One study which looked at the marital status found that those who are married are less likely to utilize ART. For severity of disease, 5 out of 6 studies used more than one outcome measure for disease stage and reported within their study contradicting results. One of the studies reported inconclusive findings for ethnicity and no study had looked at religion and sexual orientation.
CONCLUSION
It seems that men, young people, those living in certain provinces or rural areas, people who are unemployed or with a low educational level, and those being unmarried have less access to ART. As studies stem from different contexts and use different methods conclusions should be taken with caution.
Topics: Age Factors; Antiretroviral Therapy, Highly Active; Female; HIV Infections; Health Services Accessibility; Healthcare Disparities; Humans; Male; Patient Acceptance of Health Care; Risk Factors; Rural Population; Sex Factors; Socioeconomic Factors; South Africa
PubMed: 25078612
DOI: 10.1186/s12939-014-0060-z -
PloS One 2022Colorectal cancer (CRC) caused 261,060 deaths in Brazil over a 20-year period, with a tendency to increase over time. This study aimed to verify the sociodemographic... (Observational Study)
Observational Study
Colorectal cancer (CRC) caused 261,060 deaths in Brazil over a 20-year period, with a tendency to increase over time. This study aimed to verify the sociodemographic factors predicting higher mortality caused by CRC and survival rates. Moreover, we aimed to verify whether the performance of screening, diagnostic and treatment procedures had an impact on mortality. Ecological observational study of mortality due to CRC was conducted in Brazil from 2000-2019. The adjustment variable was age, which was used to calculate the age-standardized mortality rate (ASMR). The exposure variables were number of deaths and ASMR. Outcome variables were age-period-cohort, race classification, marital status, geographic region, and screening, diagnostic, and treatment procedures. Age-period-cohort analysis was performed. ANOVA and Kruskal-Wallis test with post hoc tests were used to assess differences in race classification, marital status, and geographic region. Multinomial logistic regression was used to test for interaction among sociodemographic factors. Survival analysis included Kaplan-Meier plot and Cox regression analysis were performed. Multivariate linear regression was used to test prediction using screening, diagnosis, and treatment procedures. In Brazil, mortality from CRC increased after age 45 years. The highest adjusted mortality rates were found among white individuals and in the South of the country (p < 0.05). Single, married, and widowed northern and northeastern persons had a higher risk of death than legally separated southern persons (p < 0.05). Lower survival rates were observed in brown and legally separated individuals and residents from the North (p < 0.05). An increase in first-line chemotherapy and a decrease in second-line chemotherapy were associated with high mortality in the north (p<0.05). In the south, second-line chemotherapy and abdominoperineal rectal resection were associated with high mortality (p < 0.05). Regional differences in sociodemographic factors and clinical procedures can serve as guidelines for adjusting public health policies.
Topics: Brazil; Colorectal Neoplasms; Early Detection of Cancer; Humans; Mass Screening; Middle Aged; Sociodemographic Factors
PubMed: 36107976
DOI: 10.1371/journal.pone.0274572