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Abstract
Implant therapy aims at providing the patient with a functional and esthetically pleasing rehabilitation in a long‐term perspective. The loss of an implant constitutes a major complication, which may have an impact on the treatment plan and/or jeopardize the longevity of the restoration. Implant loss may occur during the phase of osseointegration (early) or at a later time when the previously achieved osseointegration is lost (late). The present work evaluates the evidence on the occurrence of both events and discusses etiology, risk factors, and consequences.
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Affiliation(s)
- Cristiano Tomasi
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Jan Derks
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
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Pekmezi DW, Crane TE, Oster RA, Rogers LQ, Hoenemeyer T, Farrell D, Cole WW, Wolin K, Badr H, Demark-Wahnefried W. Rationale and Methods for a Randomized Controlled Trial of a Dyadic, Web-Based, Weight Loss Intervention among Cancer Survivors and Partners: The DUET Study. Nutrients 2021; 13:nu13103472. [PMID: 34684474 PMCID: PMC8539255 DOI: 10.3390/nu13103472] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 09/23/2021] [Accepted: 09/24/2021] [Indexed: 02/01/2023] Open
Abstract
Scalable, effective interventions are needed to address poor diet, insufficient physical activity, and obesity amongst rising numbers of cancer survivors. Interventions targeting survivors and their friends and family may promote both tertiary and primary prevention. The design, rationale, and enrollment of an ongoing randomized controlled trial (RCT) (NCT04132219) to test a web-based lifestyle intervention for cancer survivors and their supportive partners are described, along with the characteristics of the sample recruited. This two-arm, single-blinded RCT randomly assigns 56 dyads (cancer survivor and partner, both with obesity, poor diets, and physical inactivity) to the six-month DUET intervention vs. wait-list control. Intervention delivery and assessment are remotely performed with 0-6 month, between-arm tests comparing body weight status (primary outcome), and secondary outcomes (waist circumference, health indices, and biomarkers of glucose homeostasis, lipid regulation and inflammation). Despite COVID-19, targeted accrual was achieved within 9 months. Not having Internet access was a rare exclusion (<2%). Inability to identify a support partner precluded enrollment of 42% of interested/eligible survivors. The enrolled sample is diverse: ages 23-81 and 38% racial/ethnic minorities. Results support the accessibility and appeal of web-based lifestyle interventions for cancer survivors, though some cancer survivors struggled to enlist support partners and may require alternative strategies.
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Affiliation(s)
- Dorothy W. Pekmezi
- Department of Health Behavior, University of Alabama at Birmingham (UAB), Birmingham, AL 35294, USA
- O’Neal Comprehensive Cancer Center at University of Alabama at Birmingham (UAB), Birmingham, AL 35294, USA; (R.A.O.); (L.Q.R.); (W.D.-W.)
- Correspondence: ; Tel.: +1-205-975-8061
| | - Tracy E. Crane
- Sylvester Comprehensive Cancer Center, Miami, FL 33136, USA;
| | - Robert A. Oster
- O’Neal Comprehensive Cancer Center at University of Alabama at Birmingham (UAB), Birmingham, AL 35294, USA; (R.A.O.); (L.Q.R.); (W.D.-W.)
- Division of Preventive Medicine, Department of Medicine, Birmingham, AL 35294, USA
| | - Laura Q. Rogers
- O’Neal Comprehensive Cancer Center at University of Alabama at Birmingham (UAB), Birmingham, AL 35294, USA; (R.A.O.); (L.Q.R.); (W.D.-W.)
- Division of Preventive Medicine, Department of Medicine, Birmingham, AL 35294, USA
| | - Teri Hoenemeyer
- Department of Nutrition Sciences, University of Alabama at Birmingham (UAB), Birmingham, AL 35294, USA; (T.H.); (W.W.C.)
| | | | - William W. Cole
- Department of Nutrition Sciences, University of Alabama at Birmingham (UAB), Birmingham, AL 35294, USA; (T.H.); (W.W.C.)
| | | | - Hoda Badr
- Department of Medicine, Epidemiology and Population Sciences, Baylor College of Medicine, Houston, TX 77030, USA;
| | - Wendy Demark-Wahnefried
- O’Neal Comprehensive Cancer Center at University of Alabama at Birmingham (UAB), Birmingham, AL 35294, USA; (R.A.O.); (L.Q.R.); (W.D.-W.)
- Department of Nutrition Sciences, University of Alabama at Birmingham (UAB), Birmingham, AL 35294, USA; (T.H.); (W.W.C.)
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3
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Lin WY, Chang YH, Lin CL, Kao CH, Wu HC. Erectile dysfunction and the risk of prostate cancer. Oncotarget 2017; 8:52690-52698. [PMID: 28881762 PMCID: PMC5581061 DOI: 10.18632/oncotarget.17082] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 03/21/2017] [Indexed: 12/22/2022] Open
Abstract
Background Prostate cancer (PCa) is the most commonly diagnosed malignancy and the third leading cause of cancer death among men in developed countries. Because some risk factors are common between erectile dysfunction (ED) and PCa, we investigated the association between ED and subsequent PCa. Methods This nationwide population-based cohort study used data from the Taiwan National Health Insurance Research Database for the period 2000–2010. We identified patients newly diagnosed with ED by using codes from the International Classification of Diseases, Ninth Revision, Clinical Modification. Results In total, 5858 and 23432 patients were enrolled in the ED and non-ED cohorts, respectively. After adjustment for age, sex, and comorbidities, the overall incidence densities of PCa were significantly higher in the ED cohort than in the non-ED cohort, with an adjusted hazard ratio (aHR) of 1.19. The age-specific relative risk of PCa was significantly higher for all age groups in the ED cohort than in the non-ED cohort. Compared with patients without ED, those with organic ED had a 1.27-fold higher risk of PCa. Conclusion ED is a harbinger of PCa in some men. Physicians should consider the possibility of occult PCa in patients with ED regardless of age and comorbidities.
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Affiliation(s)
- Wei-Yu Lin
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Gia-Yi, Taiwan.,Chang Gung University of Science and Technology, Chia-Yi, Taiwan.,Department of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ying-Hsu Chang
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, LinKo, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.,School of Medicine, China Medical University, Taichung, Taiwan
| | - Chia-Hung Kao
- Graduate Institute of Clinical Medical Science, College of Medicine, China Medical University, Taichung, Taiwan.,Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan.,Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan
| | - Hsi-Chin Wu
- Department of Urology, China Medical University Hospital, Taichung, Taiwan.,Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
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4
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Moinpour CM, Donaldson GW, Davis KM, Potosky AL, Jensen RE, Gralow JR, Back AL, Hwang JJ, Yoon J, Bernard DL, Loeffler DR, Rothrock NE, Hays RD, Reeve BB, Smith AW, Hahn EA, Cella D. The challenge of measuring intra-individual change in fatigue during cancer treatment. Qual Life Res 2016; 26:259-271. [PMID: 27469506 DOI: 10.1007/s11136-016-1372-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2016] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate how well three different patient-reported outcomes (PROs) measure individual change. METHODS Two hundred and fourteen patients (from two sites) initiating first or new chemotherapy for any stage of breast or gastrointestinal cancer participated. The 13-item FACIT Fatigue scale, a 7-item PROMIS® Fatigue Short Form (PROMIS 7a), and the PROMIS® Fatigue computer adaptive test (CAT) were administered monthly online for 6 months. Reliability of measured change was defined, under a population mixed effects model, as the ratio of estimated systematic variance in rate of change to the estimated total variance of measured individual differences in rate of change. Precision of individual measured change, the standard error of measurement of change, was given by the square root of the rate-of-change sampling variance. Linear and quadratic models were examined up to 3 and up to 6 months. RESULTS A linear model for measured change showed the following by 6 and 3 months, respectively: PROMIS CAT (0.363 and 0.342); PROMIS SF (0.408 and 0.533); FACIT (0.459 and 0.473). Quadratic models offered no noteworthy improvement over linear models. Both reliability and precision results demonstrate the need to improve the measurement of intra-individual change. CONCLUSIONS These results illustrate the challenge of reliably measuring individual change in fatigue with a level of confidence required for intervention. Optimizing clinically useful measurement of intra-individual differences over time continues to pose a challenge for PROs.
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Affiliation(s)
- Carol M Moinpour
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center [Emerita], Seattle, WA, USA.
| | - Gary W Donaldson
- Pain Research Center, Department of Anesthesiology, University of Utah, Salt Lake City, UT, USA
| | - Kimberly M Davis
- Health Services Research, Georgetown University Medical Center, and Georgetown University Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Arnold L Potosky
- Health Services Research, Georgetown University Medical Center, and Georgetown University Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Roxanne E Jensen
- Health Services Research, Georgetown University Medical Center, and Georgetown University Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Julie R Gralow
- Seattle Cancer Care Alliance, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Anthony L Back
- Seattle Cancer Care Alliance, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Jimmy J Hwang
- Hematology/Oncology, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC, USA
| | - Jihye Yoon
- Cancer Prevention Program, Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Debra L Bernard
- Seattle Cancer Care Alliance, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | | | - Nan E Rothrock
- Department of Medical Social Sciences and Center for Patient-Centered Outcomes, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Ron D Hays
- Departments of Medicine and Health Services Research, University of California Los Angeles, Los Angeles, CA, USA
| | - Bryce B Reeve
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Elizabeth A Hahn
- Department of Medical Social Sciences and Center for Patient-Centered Outcomes, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - David Cella
- Department of Medical Social Sciences and Center for Patient-Centered Outcomes, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Microvascular endothelial dysfunction predicts the development of erectile dysfunction in men with coronary atherosclerosis without critical stenoses. Coron Artery Dis 2016; 25:552-7. [PMID: 25028978 DOI: 10.1097/mca.0000000000000145] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Erectile dysfunction (ED) is associated with an increased risk for cardiovascular disease, stroke, and all-cause mortality, independent of conventional cardiovascular risk factors. Coronary endothelial dysfunction is independently associated with ED in men with early coronary atherosclerosis. We aimed to investigate whether coronary microvascular dysfunction predicts development of ED in patients presenting with coronary atherosclerosis without critical stenoses. PATIENTS AND METHODS Coronary microvascular function was evaluated in 130 men with coronary atherosclerosis without critical stenoses by administration of intracoronary acetylcholine at the time of diagnostic study. After a mean follow-up of 8.4 years, patients were assessed for the development of ED by administration of a questionnaire. RESULTS In all, 68 (50%) men had microvascular endothelial dysfunction at baseline; 35 (51%) men with microvascular endothelial dysfunction developed ED on follow-up compared with 19 (31%) men without microvascular endothelial dysfunction. Men who developed ED had a lower coronary blood flow response (% [INCREMENT]CBF) compared with men who did not develop ED, with mean±SD of 25.4±71.3 versus 81.7±120 (P=0.003). In univariate analysis, microvascular endothelial dysfunction was a predictor for the development of ED, with relative risk of 2.4 (1.2-4.9) (P=0.016). In multivariate logistic regression adjusting for traditional cardiovascular risk factors (age, hypertension, hyperlipidemia, diabetes, vascular disease, and family history of coronary artery disease), only microvascular endothelial dysfunction (P=0.027) and age (P=0.044) remained significant predictors of development of ED. CONCLUSION Coronary microvascular dysfunction is a predictor of the development of ED in men with coronary atherosclerosis without critical stenoses. This study underscores the systemic involvement of the endothelial function in vascular disease.
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Di Girolamo N, Meursinge Reynders R. Deficiencies of effectiveness of intervention studies in veterinary medicine: a cross-sectional survey of ten leading veterinary and medical journals. PeerJ 2016; 4:e1649. [PMID: 26835187 PMCID: PMC4734056 DOI: 10.7717/peerj.1649] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 01/11/2016] [Indexed: 11/20/2022] Open
Abstract
The validity of studies that assess the effectiveness of an intervention (EoI) depends on variables such as the type of study design, the quality of their methodology, and the participants enrolled. Five leading veterinary journals and 5 leading human medical journals were hand-searched for EoI studies for the year 2013. We assessed (1) the prevalence of randomized controlled trials (RCTs) among EoI studies, (2) the type of participants enrolled, and (3) the methodological quality of the selected studies. Of 1707 eligible articles, 590 were EoI articles and 435 RCTs. Random allocation to the intervention was performed in 52% (114/219; 95%CI:45.2-58.8%) of veterinary EoI articles, against 87% (321/371; 82.5-89.7%) of human EoI articles (adjusted OR:9.2; 3.4-24.8). Veterinary RCTs were smaller (median: 26 animals versus 465 humans) and less likely to enroll real patients, compared with human RCTs (OR:331; 45-2441). Only 2% of the veterinary RCTs, versus 77% of the human RCTs, reported power calculations, primary outcomes, random sequence generation, allocation concealment and estimation methods. Currently, internal and external validity of veterinary EoI studies is limited compared to human medical ones. To address these issues, veterinary interventional research needs to improve its methodology, increase the number of published RCTs and enroll real clinical patients.
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Affiliation(s)
- Nicola Di Girolamo
- Department of Veterinary Sciences, University of Bologna, Bologna, Italy; Centro Veterinario Specialistico, Roma, Italy; EBMVet, Cremona, Italy
| | - Reint Meursinge Reynders
- Department of Oral and Maxillofacial Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Private practice of orthodontics, Milan, Italy
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Gritz ER, Arnold KB, Moinpour CM, Burton-Chase AM, Tangen CM, Probstfield JF, See WA, Lieber MM, Caggiano V, Moody-Thomas S, Szczepanek C, Ryan A, Carlin S, Hill S, Goodman PJ, Padberg RM, Minasian LM, Meyskens FL, Thompson IM. Factors associated with adherence to an end-of-study biopsy: lessons from the prostate cancer prevention trial (SWOG-Coordinated Intergroup Study S9217). Cancer Epidemiol Biomarkers Prev 2014; 23:1638-48. [PMID: 25028457 PMCID: PMC4119542 DOI: 10.1158/1055-9965.epi-14-0202] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The Prostate Cancer Prevention Trial (PCPT) was a 7-year randomized, double-blind, placebo-controlled trial of the efficacy of finasteride for the prevention of prostate cancer with a primary outcome of histologically determined prevalence of prostate cancer at the end of 7 years. METHODS A systematic modeling process using logistic regression identified factors available at year 6 that are associated with end-of-study (EOS) biopsy adherence at year 7, stratified by whether participants were ever prompted for a prostate biopsy by year 6. Final models were evaluated for discrimination. At year 6, 13,590 men were available for analysis. RESULTS Participants were more likely to have the EOS biopsy if they were adherent to study visit schedules and procedures and/or were in good health (P < 0.01). Participants at larger sites and/or sites that received retention and adherence grants were also more likely to have the EOS biopsy (P < 0.05). CONCLUSIONS Our results show good adherence to study requirements 1 year before the EOS biopsy was associated with greater odds that a participant would comply with the invasive EOS requirement. IMPACT Monitoring adherence behaviors may identify participants at risk of nonadherence to more demanding study end points. Such information could help frame adherence intervention strategies in future trials.
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Affiliation(s)
- Ellen R Gritz
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston
| | | | - Carol M Moinpour
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center
| | - Allison M Burton-Chase
- Department of Basic and Social Sciences, Albany College of Pharmacy and Health Sciences, Albany, New York;
| | | | | | - William A See
- Division of Urology, Froedtert Memorial Lutheran Hospital, Milwaukee, Wisconsin
| | | | | | - Sarah Moody-Thomas
- School of Public Health, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | | | - Anne Ryan
- Division of Cancer Prevention, National Cancer Institute, Rockville, Maryland; and
| | | | | | | | | | - Lori M Minasian
- Division of Cancer Prevention, National Cancer Institute, Rockville, Maryland; and
| | - Frank L Meyskens
- Chao Family Comprehensive Cancer Center, University of California Irvine, Irvine, California
| | - Ian M Thompson
- Cancer Therapy and Research Center, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
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Nehra A, Jackson G, Miner M, Billups KL, Burnett AL, Buvat J, Carson CC, Cunningham GR, Goldstein I, Guay AT, Hackett G, Kloner RA, Kostis J, Montorsi P, Ramsey M, Rosen RC, Sadovsky R, Seftel AD, Vlachopoulos C, Wu FC. Diagnosis and Treatment of Erectile Dysfunction for Reduction of Cardiovascular Risk. J Urol 2013; 189:2031-8. [DOI: 10.1016/j.juro.2012.12.107] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/26/2012] [Indexed: 01/10/2023]
Affiliation(s)
- Ajay Nehra
- Rush University Medical Center, Chicago, Illinois
| | - Graham Jackson
- Guys and St. Thomas Hospitals London, London, United Kingdom
| | - Martin Miner
- Family Medicine and Urology, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island
| | - Kevin L. Billups
- University of Minnesota, Minneapolis, Minnesota
- The James Buchanan Brady Urological Institute, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Arthur L. Burnett
- The James Buchanan Brady Urological Institute, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Jacques Buvat
- Centre d'Etude et de Traitement de la Pathologie de l'Appareil Reproducteur et de la Psychosomatique, Lille, France
| | | | - Glenn R. Cunningham
- Baylor College of Medicine and St. Luke's Episcopal Hospital, Houston, Texas
| | | | - Andre T. Guay
- Center for Sexual Function/Endocrinology, Lahey Clinic Medical Center, Peabody, Massachusetts
- Tufts University School of Medicine, Boston, Massachusetts
| | - Geoff Hackett
- Good Hope Hospital, Birmingham and Andrology Research Unit, Developmental and Regenerative Biomedicine Research Group, The University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Robert A. Kloner
- Good Samaritan Hospital and Department of Medicine, Keck School of Medicine at University of Southern California, Los Angeles, California
| | - John Kostis
- University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Piero Montorsi
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico, Institute of Cardiology University of Milan, Milan, Italy
| | - Melinda Ramsey
- Complete Healthcare Communications, Inc., Chadds Ford, Pennsylvania
| | | | - Richard Sadovsky
- State University of New York-Downstate Medical Center, Brooklyn, New York
| | - Allen D. Seftel
- University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, New Jersey
- Cooper University Hospital, Camden, New Jersey
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9
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Nehra A, Jackson G, Miner M, Billups KL, Burnett AL, Buvat J, Carson CC, Cunningham GR, Ganz P, Goldstein I, Guay AT, Hackett G, Kloner RA, Kostis J, Montorsi P, Ramsey M, Rosen R, Sadovsky R, Seftel AD, Shabsigh R, Vlachopoulos C, Wu FCW. The Princeton III Consensus recommendations for the management of erectile dysfunction and cardiovascular disease. Mayo Clin Proc 2012. [PMID: 22862865 DOI: 10.1016/j.mayocp] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The Princeton Consensus (Expert Panel) Conference is a multispecialty collaborative tradition dedicated to optimizing sexual function and preserving cardiovascular health. The third Princeton Consensus met November 8 to 10, 2010, and had 2 primary objectives. The first objective focused on the evaluation and management of cardiovascular risk in men with erectile dysfunction (ED) and no known cardiovascular disease (CVD), with particular emphasis on identification of men with ED who may require additional cardiologic work-up. The second objective focused on reevaluation and modification of previous recommendations for evaluation of cardiac risk associated with sexual activity in men with known CVD. The Panel's recommendations build on those developed during the first and second Princeton Consensus Conferences, first emphasizing the use of exercise ability and stress testing to ensure that each man's cardiovascular health is consistent with the physical demands of sexual activity before prescribing treatment for ED, and second highlighting the link between ED and CVD, which may be asymptomatic and may benefit from cardiovascular risk reduction.
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Affiliation(s)
- Ajay Nehra
- Department of Urology, Mayo Clinic, Rochester, MN 55905, USA.
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10
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Moinpour CM, Darke AK, Donaldson GW, Cespedes D, Johnson CR, Ganz PA, Patrick DL, Ware JE, Shumaker SA, Meyskens FL, Thompson IM. Health-related quality-of-life findings for the prostate cancer prevention trial. J Natl Cancer Inst 2012; 104:1373-85. [PMID: 22972968 DOI: 10.1093/jnci/djs359] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The Prostate Cancer Prevention Trial (PCPT)-a randomized placebo-controlled study of the efficacy of finasteride in preventing prostate cancer-offered the opportunity to prospectively study effects of finasteride and other covariates on the health-related quality of life of participants in a multiyear trial. METHODS We assessed three health-related quality-of-life domains (measured with the Health Survey Short Form-36: Physical Functioning, Mental Health, and Vitality scales) via questionnaires completed by PCPT participants at enrollment (3 months before randomization), at 6 months after randomization, and annually for 7 years. Covariate data obtained at enrollment from patient-completed questionnaires were included in our model. Mixed-effects model analyses and a cross-sectional presentation at three time points began at 6 months after randomization. All statistical tests were two-sided. RESULTS For the physical function outcome (n = 16 077), neither the finasteride main effect nor the finasteride interaction with time were statistically significant. The effects of finasteride on physical function were minor and accounted for less than a 1-point difference over time in Physical Functioning scores (mixed-effect estimate = 0.07, 95% confidence interval [CI] = -0.28 to 0.42, P = .71). Comorbidities such as congestive heart failure (estimate = -5.64, 95% CI = -7.96 to -3.32, P < .001), leg pain (estimate = -2.57, 95% CI = -3.04 to -2.10, P < .001), and diabetes (estimate = -1.31, 95% CI = -2.04 to -0.57, P < .001) had statistically significant negative effects on physical function, as did current smoking (estimate = -2.34, 95% CI = -2.97 to -1.71, P < .001) and time on study (estimate = -1.20, 95% CI = -1.36 to -1.03, P < .001). Finasteride did not have a statistically significant effect on the other two dependent variables, mental health and vitality, either in the mixed-effects analyses or in the cross-sectional analysis at any of the three time points. CONCLUSION Finasteride did not negatively affect SF-36 Physical Functioning, Mental Health, or Vitality scores.
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Affiliation(s)
- Carol M Moinpour
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, M3-C102 1100 Fairview Ave North, PO Box 19024 Seattle, WA 98109-1024, USA.
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11
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Nehra A, Jackson G, Miner M, Billups KL, Burnett AL, Buvat J, Carson CC, Cunningham GR, Ganz P, Goldstein I, Guay AT, Hackett G, Kloner RA, Kostis J, Montorsi P, Ramsey M, Rosen R, Sadovsky R, Seftel AD, Shabsigh R, Vlachopoulos C, Wu FCW. The Princeton III Consensus recommendations for the management of erectile dysfunction and cardiovascular disease. Mayo Clin Proc 2012; 87:766-78. [PMID: 22862865 PMCID: PMC3498391 DOI: 10.1016/j.mayocp.2012.06.015] [Citation(s) in RCA: 268] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Revised: 06/11/2012] [Accepted: 06/11/2012] [Indexed: 02/07/2023]
Abstract
The Princeton Consensus (Expert Panel) Conference is a multispecialty collaborative tradition dedicated to optimizing sexual function and preserving cardiovascular health. The third Princeton Consensus met November 8 to 10, 2010, and had 2 primary objectives. The first objective focused on the evaluation and management of cardiovascular risk in men with erectile dysfunction (ED) and no known cardiovascular disease (CVD), with particular emphasis on identification of men with ED who may require additional cardiologic work-up. The second objective focused on reevaluation and modification of previous recommendations for evaluation of cardiac risk associated with sexual activity in men with known CVD. The Panel's recommendations build on those developed during the first and second Princeton Consensus Conferences, first emphasizing the use of exercise ability and stress testing to ensure that each man's cardiovascular health is consistent with the physical demands of sexual activity before prescribing treatment for ED, and second highlighting the link between ED and CVD, which may be asymptomatic and may benefit from cardiovascular risk reduction.
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Key Words
- abi, ankle-brachial index
- accf, american college of cardiology foundation
- aha, american heart association
- bmi, body mass index
- bp, blood pressure
- cacs, coronary artery calcium scoring
- cad, coronary artery disease
- ccta, coronary computed tomographic angiography
- cimt, carotid intima-media thickness
- cvd, cardiovascular disease
- ed, erectile dysfunction
- est, exercise stress testing
- frs, framingham risk score
- hdl, high-density lipoprotein
- hscrp, high-sensitivity c-reactive protein
- loe, level of evidence
- mets, metabolic equivalents of the task
- mi, myocardial infarction
- nyha, new york heart association
- pad, peripheral artery disease
- pde5, phosphodiesterase type 5
- pwv, pulse wave velocity
- trt, testosterone replacement therapy
- tt, total testosterone
- wc, waist circumference
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Affiliation(s)
- Ajay Nehra
- Department of Urology, Mayo Clinic, Rochester, MN 55905, USA.
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Briancon S, Boini S, Bertrais S, Guillemin F, Galan P, Hercberg S. Long-term antioxidant supplementation has no effect on health-related quality of life: The randomized, double-blind, placebo-controlled, primary prevention SU.VI.MAX trial. Int J Epidemiol 2011; 40:1605-16. [DOI: 10.1093/ije/dyr161] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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Long-term quality of life outcome after proton beam monotherapy for localized prostate cancer. Int J Radiat Oncol Biol Phys 2011; 82:e201-9. [PMID: 21621343 DOI: 10.1016/j.ijrobp.2011.03.048] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2010] [Revised: 03/17/2011] [Accepted: 03/31/2011] [Indexed: 11/22/2022]
Abstract
OBJECTIVES High-dose external radiation for localized prostate cancer results in favorable clinical outcomes and low toxicity rates. Here, we report long-term quality of life (QOL) outcome for men treated with conformal protons. METHODS QOL questionnaires were sent at specified intervals to 95 men who received proton radiation. Of these, 87 men reported 3- and/or 12-month outcomes, whereas 73 also reported long-term outcomes (minimum 2 years). Symptom scores were calculated at baseline, 3 months, 12 months, and long-term follow-up. Generalized estimating equation models were constructed to assess longitudinal outcomes while accounting for correlation among repeated measures in an individual patient. Men were stratified into functional groups from their baseline questionnaires (normal, intermediate, or poor function) for each symptom domain. Long-term QOL changes were assessed overall and within functional groups using the Wilcoxon signed-rank test. RESULTS Statistically significant changes in all four symptom scores were observed in the longitudinal analysis. For the 73 men reporting long-term outcomes, there were significant change scores for incontinence (ID), bowel (BD) and sexual dysfunction (SD), but not obstructive/irritative voiding dysfunction (OID). When stratified by baseline functional category, only men with normal function had increased scores for ID and BD. For SD, there were significant changes in men with both normal and intermediate function, but not poor function. CONCLUSIONS Patient reported outcomes are sensitive indicators of treatment-related morbidity. These results quantitate the long-term consequences of proton monotherapy for prostate cancer. Analysis by baseline functional category provides an individualized prediction of long-term QOL scores. High dose proton radiation was associated with small increases in bowel dysfunction and incontinence, with more pronounced changes in sexual dysfunction.
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14
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Han M, Trock BJ, Partin AW, Humphreys EB, Bivalacqua TJ, Guzzo TJ, Walsh PC. The impact of preoperative erectile dysfunction on survival after radical prostatectomy. BJU Int 2011; 106:1612-7. [PMID: 20590546 DOI: 10.1111/j.1464-410x.2010.09472.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
PURPOSE Erectile dysfunction (ED) and cardiovascular disease (CVD) share etiology and pathophysiology. The underlying pathology for preoperative ED may adversely affect survival following radical prostatectomy (RP). We examined the association between preoperative ED and survival following RP. MATERIALS AND METHODS Between 1983 and 2000, a single surgeon performed RP on 2511 men, with preoperative ED (ED group, n= 231, 9.2%) or without ED (No ED group, n= 2280, 90.8%). We retrospectively analysed their CVD-specific survival (CVDSS), prostate cancer-specific survival (PCSS), non-PCSS (NPCSS) and overall survival (OS) from time of surgery. RESULTS With median follow-up of 13 years after RP, 449 men (18%) died (140 from prostate cancer, 309 from other causes). Kaplan-Meier analyses demonstrated significant differences in CVDSS (P < 0.001), NPCSS (P < 0.001) and OS (P < 0.001), but not in PCSS (P= 0.12), between the ED group vs No ED group. In univariate proportional hazards analyses, preoperative ED was associated with a significant decrease in OS, hazard ratio (HR), 1.71 (95% CI, 1.34-2.23), P < 0.001. However, in multivariable analyses, the association of ED with survival became non-significant (HR, 1.25 (95% CI, 0.97-1.66), P= 0.111) after adjusting for other prognostic factors, such as age, preoperative prostate-specific antigen (PSA) level, Gleason score, pathologic stage, body mass index and Charlson Comorbidity Index. CONCLUSIONS Preoperative ED is associated with decreased overall survival and survival from causes other than prostate cancer following RP. However, preoperative ED was not an independent predictor of overall survival after adjusting for other predictors of survival. Urologists should carefully assess pretreatment ED status to enhance appropriate treatment recommendation for men with prostate cancer.
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Affiliation(s)
- Misop Han
- James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
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Halbert CH, Wrenn G, Weathers B, Delmoor E, Ten Have T, Coyne JC. Sociocultural determinants of men's reactions to prostate cancer diagnosis. Psychooncology 2010; 19:553-60. [PMID: 19408346 DOI: 10.1002/pon.1574] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To develop a better understanding of how men react to being diagnosed with prostate cancer and identify factors that influence these responses, we conducted an observational study to identify sociocultural predictors of men's psychological reactions. METHODS Participants were 70 African American and 124 white prostate cancer patients who completed a structured telephone interview that evaluated psychological reactions in terms of intrusive thoughts about cancer and attempts to avoid cancer-related thoughts and feelings. Perceptions of disease-specific stress, cultural beliefs and values, and social constraints were also assessed during the interview. RESULTS There were no racial differences in men's reactions to being diagnosed with prostate cancer; however, greater perceptions of disease-specific stress, increasing levels of present temporal orientation, and more social constraints had significant positive effects on avoidant reactions. Greater perceptions of stress also had a significant positive effect on intrusive thoughts. CONCLUSIONS The results of this study highlight the need for individualized approaches to help men address their thoughts and feelings about being diagnosed with prostate cancer. These efforts should include strategies that help men to communicate more effectively with social support resources and address cultural beliefs and values related to temporal orientation.
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Affiliation(s)
- Chanita Hughes Halbert
- Department of Psychiatry and Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA 19104, USA.
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16
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Malmi H, Ruutu M, Määttänen L, Stenman UH, Juusela H, Tammela TL, Auvinen A. Why do men opt out of prostate-cancer screening? Attitudes and perception among participants and non-participants of a screening trial. BJU Int 2010; 106:472-7. [DOI: 10.1111/j.1464-410x.2010.09165.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Dušková M, Hill M, Stárka L. The influence of low dose finasteride, a type II 5α-reductase inhibitor, on circulating neuroactive steroids. Horm Mol Biol Clin Investig 2010; 1:95-102. [PMID: 25961975 DOI: 10.1515/hmbci.2010.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2009] [Accepted: 08/28/2009] [Indexed: 11/15/2022]
Abstract
BACKGROUND Finasteride is a 5α-reductase inhibitor that has received clinical approval for the treatment of human benign prostatic hyperplasia and androgenetic alopecia. The treatment is practically without side effects, although some occasional cases of depression syndrome have been reported. 5α-Reductase is an enzyme responsible for the reduction of testosterone, progesterone or deoxycorticosterone to their 5α-reduced derivatives possessing anticonvulsant, antidepressant, and anxiolytic activity. Therefore, the formation of GABAergic neuroactive steroids is likely to be impacted by finasteride. OBJECTIVE The objective of the study was to show how the treatment of premature androgenetic alopecia with low doses (1 mg/day) of finasteride influences the broad spectrum of steroids with potential neuroactivity. METHODS A group of 12 men with premature androgenetic alopecia participated in the present study. The steroid hormone profile was determined for all individuals. Finasteride was administered for 4 months at a daily dose of 1 mg. After the treatment, the same hormonal profile was determined again. RESULTS 5α-Reduced steroids, e.g., 5α-dihydrotestosterone, androsterone, epiandrosterone, 5α-androstene-3α,17β-diol, allopregnanolone, isopregnaolone, and some 5-ene steroids, such as dehydroepiandrosterone and pregnenolone, decreased gradually during treatment. CONCLUSIONS The decrease of 5α-reduced steroids, especially of allopregnanediol, dihydrotestosterone, and pregnenolone, is probably one of the factors responsible for the increased occurrence of depression in men treated with finasteride, even at low doses.
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Bouwman II, Van Der Heide WK, Van Der Meer K, Nijman R. Correlations between lower urinary tract symptoms, erectile dysfunction, and cardiovascular diseases: Are there differences between male populations from primary healthcare and urology clinics? A review of the current knowledge. Eur J Gen Pract 2009; 15:128-35. [DOI: 10.3109/13814780903329536] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
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Halbert CH, Weathers B, Delmoor E, Mahler B, Coyne J, Thompson HS, Have TT, Vaughn D, Malkowicz SB, Lee D. Racial differences in medical mistrust among men diagnosed with prostate cancer. Cancer 2009; 115:2553-61. [PMID: 19296516 DOI: 10.1002/cncr.24249] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Mistrust of healthcare providers and systems is a significant barrier to quality healthcare. However, limited empirical data are available on perceptions of medical mistrust among individuals who are diagnosed with cancer. The objective of this study was to identify sociodemographic, clinical, and cultural determinants of mistrust among men diagnosed with prostate cancer. METHODS The authors conducted an observational study among 196 African-American men (n = 71) and white men (n = 125) who were newly diagnosed with prostate cancer during 2003 through 2007. RESULTS Race, education, healthcare experiences, and cultural factors had significant effects on mistrust. African-American men (P = .01) and men who had fewer years of formal education (P = .001) reported significantly greater levels of mistrust compared with white men and men who had more education. Mistrust also was greater among men who had been seeing their healthcare provider for a longer period (P = .01) and among men with lower perceptions of interdependence (P = .01). CONCLUSIONS The current findings suggested that efforts to enhance trust among men who are diagnosed with prostate cancer should target African-American men, men with fewer socioeconomic resources, and men with lower perceptions of interdependence. Reasons for deterioration in trust associated with greater experience with specialty providers should be explored along with the effects of interventions that are designed to address the concerns of individuals who have greater mistrust.
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Affiliation(s)
- Chanita Hughes Halbert
- Department of Psychiatry and Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.
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Gur S, Kadowitz PJ, Hellstrom WJG. A review of current progress in gene and stem cell therapy for erectile dysfunction. Expert Opin Biol Ther 2008; 8:1521-38. [DOI: 10.1517/14712598.8.10.1521] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Hodges LD, Kirby M, Solanki J, O'Donnell J, Brodie DA. The temporal relationship between erectile dysfunction and cardiovascular disease. Int J Clin Pract 2007; 61:2019-25. [PMID: 17997808 DOI: 10.1111/j.1742-1241.2007.01629.x] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Erectile dysfunction (ED) and cardiovascular disease (CVD) share similar risk factors, and ED may be a marker of CVD progression. The study assessed: (i) the temporal relationship between ED and CVD and (ii) the UK incidence of ED, in patients with CVD and an age-matched control group. DESIGN After ethics approval, 207 patients (CVD group) attending cardiovascular rehabilitation programmes and 165 age-matched subjects (control group), from GP practices across the UK, completed up to four questionnaires [ED details, The International Index of Erectile Function (IIEF) (before and after a cardiovascular event) and ED related Quality of Life]. A health professional also completed a medical details questionnaire. RESULTS Erectile dysfunction was reported by 66% of individuals with CVD, with a mean duration of 5 +/- 5.3 years. The control group was significantly different (p < 0.05) in both incidence (37%) and mean duration (6.6 +/- 6.8 years). Only 53% of the CVD group and 43% of the control group had discussed their symptoms of ED with a health professional. The IIEF demonstrated that ED became significantly worse (p < 0.05) after a cardiovascular event, changing from moderate to severe (13-10). CONCLUSIONS From these data, it is now evident that ED may precede a cardiovascular event by as much as 5 years. In almost half of the men with ED, there were missed opportunities to undertake a CVD risk assessment and provide an intervention, because the men did not acknowledge the problem. Men with ED should be specifically targeted for CVD preventative strategies in terms of lifestyle changes, and appropriate pharmacological treatments.
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Affiliation(s)
- L D Hodges
- Research Centre for Society and Health, Buckinghamshire Chilterns University College, Buckinghamshire, UK.
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22
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Beuzeboc P, Cornud F, Eschwege P, Gaschignard N, Grosclaude P, Hennequin C, Maingon P, Molinié V, Mongiat-Artus P, Moreau JL, Paparel P, Péneau M, Peyromaure M, Revery V, Rébillard X, Richaud P, Salomon L, Staerman F, Villers A. Cancer de la prostate. Prog Urol 2007; 17:1159-230. [DOI: 10.1016/s1166-7087(07)74785-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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23
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Moinpour CM, Darke AK, Donaldson GW, Thompson IM, Langley C, Ankerst DP, Patrick DL, Ware JE, Ganz PA, Shumaker SA, Lippman SM, Coltman CA. Longitudinal Analysis of Sexual Function Reported by Men in the Prostate Cancer Prevention Trial. J Natl Cancer Inst 2007; 99:1025-35. [PMID: 17596576 DOI: 10.1093/jnci/djm023] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The Prostate Cancer Prevention Trial (PCPT) was a randomized, double-blind, placebo-controlled study of the efficacy of finasteride in preventing prostate cancer in 18,882 men aged 55 years or older. The PCPT offered an opportunity to prospectively study the effects of finasteride and other covariates on sexual dysfunction. METHODS We assessed sexual dysfunction in 17,313 PCPT participants during a 7-year period. A battery of questionnaires assessed sexual dysfunction (Sexual Activity Scale score); age; race; SF-36 Mental Health Inventory-5, Physical Function, and Vitality scores; body mass index; smoking status; and the presence of diabetes and hypertension. Assessments began at month 6 after random assignment and included the Sexual Activity Scale score at randomization as a covariate. Two-sided general t tests, with a cutoff of P value less than .05, were used to determine the statistical significance for mixed model effects with correlated random time slopes and intercepts. The changing impact of covariates on sexual dysfunction was also assessed at 6 months, 3.5 years, and 6.5 years after randomization. RESULTS Finasteride increased sexual dysfunction only slightly and its impact diminished over time; the increase in the Sexual Activity Scale score relative to placebo of 3.21 points (95% confidence interval [CI] = 2.83 to 3.59 points; P<.001) at the first assessment decreased to 2.11 points (95% CI = 1.44 to 2.81 points; P<.001) at the end of study. These Sexual Activity score values were small on a scale of 0-100, the range observed in the study, and in comparison with individual variation. After adjustment for all covariates, mean sexual dysfunction increased in both arms from baseline (6 months after randomization) by 1.26 Sexual Activity points (95% CI = 1.16 to 1.36 points; P<.001) per year, corresponding to a cumulative increase of 8.22 points (95% CI = 7.52 to 8.92 points; P<.001) over the study period. CONCLUSIONS The effect of finasteride on sexual functioning is minimal for most men and should not impact the decision to prescribe or take finasteride.
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Affiliation(s)
- Carol M Moinpour
- Southwest Oncology Group Statistical Center, Fred Hutchinson Cancer Research Center/M3-C102, 1100 Fairview Ave North, Box 19024, Seattle, WA 98109-1024, USA.
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Burwell SR, Case LD, Kaelin C, Avis NE. Sexual Problems in Younger Women After Breast Cancer Surgery. J Clin Oncol 2006; 24:2815-21. [PMID: 16782919 DOI: 10.1200/jco.2005.04.2499] [Citation(s) in RCA: 162] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose To examine sexual problems in younger women diagnosed with breast cancer during the first year after surgery and to identify sociodemographic, medical, and psychosocial predictors of sexual problems. Patients and Methods Women diagnosed with breast cancer age ≤ 50 years completed surveys at three time points: within 24 weeks after initial surgery (baseline), 6 weeks after baseline, and 6 months later. Survey items included the Medical Outcomes Study Sexual Functioning Scale, satisfaction with sex life, feeling sexually attractive, body image, marital satisfaction, quality of life, medical history, symptoms, and sociodemographics. Prediagnosis sexual problems were retrospectively ascertained at the initial survey. Results Analyses included 209 women sexually active at baseline (78.6% of total sample). Sexual problems were significantly greater immediately postsurgery compared with retrospective reports before diagnosis (P < .0001). Although problems gradually decreased over time, they were still greater at 1 year postsurgery than before diagnosis. In multivariate analyses controlling for sexual problems at prediagnosis, vaginal dryness, and lower perceived sexual attractiveness were consistently related to greater overall sexual problems. Chemotherapy was related to sexual problems only at baseline except for women who became menopausal as a result of chemotherapy, who continued to have problems. Conclusion Findings substantiate the need to address potential sexual problems related to chemotherapy treatment and menopause among younger breast cancer survivors and to counsel women about possible remedies, particularly for vaginal dryness. Increasing feelings of sexual attractiveness may also help sexual problems, especially among women for whom these feelings were altered by surgery or treatment.
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Affiliation(s)
- Stephanie R Burwell
- University of Georgia, Department of Child and Family Development, Athens, GA, USA
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Lewinshtein DJ, Perrotte P, Lebeau T, Ramirez A, Benayoun S, Karakiewicz PI. Normal urinary and sexual function in men without evidence of prostate cancer from Montreal, Canada. BJU Int 2006; 97:1273-7. [PMID: 16686725 DOI: 10.1111/j.1464-410x.2006.06155.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To examine the rates of stress urinary incontinence (SUI) and erectile dysfunction (ED), and of associated bother, in men with no evidence of prostate cancer who participated in a prostate cancer-screening event. SUBJECTS AND METHODS A cohort of 366 men with no established diagnosis of prostate cancer completed a questionnaire addressing SUI, ED and associated bother. Socio-economic status and presence of comorbidities were also examined. RESULTS The mean (range) age of the men was 54.8 (33-80) years; 90% of the men (271) had no SUI, and 76% (231) reported no urinary bother. Conversely, 62% (189) reported some degree of ED and 27% (82) some degree of sexual bother. Urinary bother (P < 0.001), erectile function (P < 0.001), and sexual bother (P < 0.02) were associated with age. Of all the men, 36% had one or more comorbidities. Men with one or more comorbidities had worse erectile function than those men with no comorbidity (P < 0.05). CONCLUSION Few studies address normative values of SUI and ED rates in men with no established diagnosis of prostate cancer. We quantified the rate of SUI and it was practically negligible. Conversely, some degree of ED affected most of the present screened population. These data may be used as baseline references to evaluate the magnitude of functional and bother detriments after various prostate treatments.
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Affiliation(s)
- Daniel J Lewinshtein
- Cancer Prognostics and Health Outcomes Unit, University of Montreal, Montreal, Quebec, Canada
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Thompson IM, Tangen CM, Klein EA, Lippman SM. Phase III prostate cancer prevention trials: are the costs justified? J Clin Oncol 2005; 23:8161-4. [PMID: 16278467 DOI: 10.1200/jco.2005.02.7987] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
One randomized, prospective clinical trial for chemoprevention of prostate cancer has been completed, and two additional trials are ongoing. The investment, time, and effort for these trials are substantial. We reviewed the outcomes of these trials to address the value of the investment. The outcomes of the Prostate Cancer Prevention Trial (testing finasteride) and the design of the Selenium and Vitamin E Cancer Prevention Trial (SELECT; testing vitamin E and selenium) trial as well as the Reduction by Dutasteride of Prostate Cancer Events (REDUCE) trial (testing dutasteride) were reviewed. From a public health standpoint, there is tremendous potential for benefit from large-scale cancer prevention trials. Because of the volume of data that are collected, potential discoveries related to the biology of the disease are substantial. Translational scientific efforts are direct outgrowths of these studies. Prospective, randomized chemoprevention trials for prostate and other cancers are expensive and require long periods of time to conduct, yet the rewards are on a par with the investment.
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Affiliation(s)
- Ian M Thompson
- Department of Urology, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229, USA.
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Gilligan T. Social disparities and prostate cancer: mapping the gaps in our knowledge. Cancer Causes Control 2005; 16:45-53. [PMID: 15750857 DOI: 10.1007/s10552-004-1291-x] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2004] [Accepted: 07/11/2004] [Indexed: 11/26/2022]
Abstract
To evaluate the current state of our knowledge regarding social disparities and prostate cancer and to map the domains where substantial knowledge has been acquired as well as those where little is known, with the purpose of identifying important areas for future research. A Medline research was conducted to identify published papers regarding social disparities in prostate cancer since 1990. The results of this review are presented in a social disparities and prostate cancer grid designed to highlight which domains of social disparities have been researched and which neglected. The major social disparity in prostate cancer concerns the extremely high prostate cancer incidence and mortality seen among black Americans. This is also the area where the most research has been performed. Low socioeconomic position is associated with poorer prostate cancer outcomes but not with higher prostate cancer incidence. It remains poorly defined to what extent racial/ethnic differences in prostate cancer result from differences in socioeconomic position (SEP). Understanding the causes of the high prostate cancer mortality seen among black men remains the major challenge in the area of social disparities and prostate cancer.
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Affiliation(s)
- Timothy Gilligan
- Department of Medicine, Department of Medical Oncology, Harvard Medical School, Dana-Farber Cancer Institute, 44 Binnery St, D-1230 Boston, MA 02115, USA.
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Flach SD, McCoy KD, Vaughn TE, Ward MM, Bootsmiller BJ, Doebbeling BN. Does patient-centered care improve provision of preventive services? J Gen Intern Med 2004; 19:1019-26. [PMID: 15482554 PMCID: PMC1492576 DOI: 10.1111/j.1525-1497.2004.30395.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVES While patient-centered care (PCC) is desirable for many reasons, its relationship to treatment outcomes is controversial. We evaluated the relationship between PCC and the provision of preventive services. METHODS We obtained facility-level estimates of how well each VA hospital provided PCC from the 1999 ambulatory Veterans Satisfaction Survey. PCC delivery was measured by the average percentage of responses per facility indicating satisfactory performance from items in 8 PCC domains: access, incorporating patient preferences, patient education, emotional support, visit coordination, overall coordination of care, continuity, and courtesy. Additional predictors included patient population and facility characteristics. Our outcome was a previously validated hospital-level benchmarking score describing facility-level performance across 12 U.S. Preventive Services Task Force-recommended interventions, using the 1999 Veterans Health Survey. RESULTS Facility-level delivery of preventive services ranged from an overall mean of 90% compliance for influenza vaccinations to 18% for screening for seat belt use. Mean overall PCC scores ranged from excellent (>90% for the continuity of care and courtesy of care PCC domains) to modest (<70% for patient education). Correlates of better preventive service delivery included how often patients were able to discuss their concerns with their provider, the percent of visits at which patients saw their usual provider, and the percent of patients receiving >90% of care from a VA hospital. CONCLUSION Improved communication between patients and providers, and continuity of care are associated with increased provision of preventive services, while other aspects of PCC are not strongly related to delivery of preventive services.
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Affiliation(s)
- Stephen D Flach
- Iowa City Veterans Affairs Medical Center, Public Policy Center, University of Iowa, Iowa City, Iowa, USA.
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Bruner DW, Movsas B, Konski A, Roach M, Bondy M, Scarintino C, Scott C, Curran W. Outcomes research in cancer clinical trial cooperative groups: the RTOG model. Qual Life Res 2004; 13:1025-41. [PMID: 15287270 DOI: 10.1023/b:qure.0000031335.02254.3b] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND The Radiation Therapy Oncology Group (RTOG), a National Cancer Institute sponsored cancer clinical trials research cooperative, has recently formed an Outcomes Committee to assess a comprehensive array of clinical trial endpoints and factors impacting the net effect of therapy. METHODS To study outcomes in a consistent, comprehensive and coordinated manner, the RTOG Outcomes Committee developed a model to assess clinical, humanistic, and economic outcomes important in clinical trials. RESULTS This paper reviews how the RTOG incorporates outcomes research into cancer clinical trials, and demonstrates utilization of the RTOG Outcomes Model to test hypotheses related to non-small-cell lung cancer (NSCLC). In this example, the clinical component of the model indicates that the addition of chemotherapy to radiotherapy (RT) improves survival but increases the risk of toxicity. The humanistic component indicates that esophagitis is the symptom impacting quality of life the greatest and may outweigh the benefits in elderly (> or =70 years) patients. The economic component of the model indicates that accounting for quality-adjusted survival, concurrent chemoRT for the treatment of NSCLC is within the range of economically acceptable recommendations. CONCLUSION The RTOG Outcomes Model guides a comprehensive program of research that systematically measures a triad of endpoints considered important to clinical trials research.
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Affiliation(s)
- D W Bruner
- Radiation Therapy Oncology Group, Philadelphia, PA, USA.
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Taylor KL, Shelby R, Gelmann E, McGuire C. Quality of life and trial adherence among participants in the prostate, lung, colorectal, and ovarian cancer screening trial. J Natl Cancer Inst 2004; 96:1083-94. [PMID: 15265970 DOI: 10.1093/jnci/djh194] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The National Cancer Institute's Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial was designed to examine whether annual screening tests for these four tumor sites result in reduced disease-related mortality. We assessed the impact of trial participation on both health-related quality of life (HRQL) and trial adherence. METHODS Participants (N = 432; 217 in the control arm and 215 in screening arm) were accrued from the Georgetown University PLCO site from May through December 1998. Screening-arm participants were interviewed by telephone at baseline (prescreening), shortly after notification of screening results (short-term follow-up), and 9 months after notification of screening results (intermediate-term follow up). Control-arm participants completed a baseline and 1-year follow-up assessment. Logistic regression analyses were conducted. RESULTS Participants reported high levels of HRQL and satisfaction with their decision to participate. Screening-arm participants with abnormal screening results had a higher level of intrusive thoughts about cancer than those with all normal results (odds ratio [OR] = 2.9, 95% confidence interval [CI] = 1.3 to 6.3) at the short-term follow-up but not at the intermediate-term follow-up (when abnormal test results were known to be false positive; OR = 1.9, 95% CI = 0.89 to 4.2). Trial adherence was statistically significantly better among participants who had received all normal results in the previous year's screening tests (93.7% versus 78.7%; OR = 3.7, CI = 1.1 to 12.0) than in those who received at least one abnormal result. In the control arm, adherence (defined as returning annual questionnaires) was positively associated with education (OR = 3.4, 95% CI = 1.4 to 8.4) and sex, with women being more likely to return questionnaires than men (OR = 2.1, 95% CI = 1.05 to 4.4). CONCLUSIONS It is feasible to collect HRQL measures as part of a large cancer screening trial. Prior abnormal screening results were related to short-term HRQL but not to intermediate-term HRQL. Trial adherence was poorer among those who had received previous false-positive results. These results suggest several methods for improving adherence in this and other subgroups.
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Affiliation(s)
- Kathryn L Taylor
- Cancer Control Program, Lombardi Comprehensive Cancer Center, Georgetown University, 2233 Wisconsin Ave., NW, Ste. 317, Washington, DC 20007, USA.
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Cullen J, Schwartz MD, Lawrence WF, Selby JV, Mandelblatt JS. Short-term impact of cancer prevention and screening activities on quality of life. J Clin Oncol 2004; 22:943-52. [PMID: 14990651 DOI: 10.1200/jco.2004.05.191] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE There are few data on the short-term effects of participating in cancer prevention activities, undergoing genetic risk assessment, or having routine screening. The objective of this article is to systematically review existing research on short-term effects of prevention, genetic counseling and testing, and screening activities on quality of life. METHODS We conducted a MEDLINE search for original research studies that were published between January 1, 1985, and December 31, 2002, and conducted in North America or Western Europe. Data were abstracted and summarized using a standardized format. RESULTS We reviewed 210 publications. Most studies focused on psychological states (anxiety, depression), symptoms, or general health status. One hundred thirty-one studies used 51 previously validated noncancer instruments. Many researchers (12.6%) also added cancer-specific measures, such as perceived cancer risk or symptom indices. Only one study measured satisfaction or quality of provider-client communication. While one report examined lost workdays, no other economic consequences of short-term outcomes were evaluated. Among seven studies that assessed short-term outcomes preferences, only four specifically used time trade-off or linear rating scale methods. No study used standard gamble or willingness-to-pay methods. The overwhelming majority of research indicated that short-term effects were transient. Only two studies linked short-term effects to long-term cancer-related health behaviors such as repeat screening. CONCLUSION There is considerable heterogeneity in short-term outcome measurement. Clinicians need to be aware of potential for short-term, transient adverse effects. The impact of short-term experiences should to be linked to long-term health status and use of services.
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Affiliation(s)
- Jennifer Cullen
- Department of Oncology, Georgetown University, 2233 Wisconsin Ave NW, Suite 440, Washington, DC, USA.
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Yabroff KR, Gordis L. Does stage at diagnosis influence the observed relationship between socioeconomic status and breast cancer incidence, case-fatality, and mortality? Soc Sci Med 2004; 57:2265-79. [PMID: 14572836 DOI: 10.1016/s0277-9536(03)00100-x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Historically, lower socioeconomic status (SES) has been reported to be associated with decreased breast cancer incidence and mortality and increased case-fatality, although recent trends in breast cancer screening and treatment may alter these relationships. This study assessed the associations between SES and breast cancer incidence, case-fatality, and mortality by stage of disease at diagnosis using recent data in the United States. Breast cancer incidence and survival data from the Surveillance, Epidemiology, and End Results (SEER) tumor registry for black and white women aged 55 and above were linked to county level SES and population data based on place of residence. Poisson regression was used to calculate age-adjusted relative rates associated with SES levels and breast cancer incidence, case-fatality, and mortality. As SES decreased, localized breast cancer incidence rates decreased, while incidence rates of distant disease increased. Five-year localized and regional breast cancer case-fatality rates increased as SES decreased. Localized breast cancer mortality rates decreased as SES declined, whereas regional breast cancer mortality rates tended to increase. These results confirm some previously reported findings and suggest that associations between lower SES and lower localized breast cancer mortality rates are influenced mainly by underlying associations between SES and localized breast cancer incidence, whereas regional breast cancer mortality rates appear to reflect the underlying association between SES and regional case-fatality rates.
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Affiliation(s)
- K Robin Yabroff
- Department of Epidemiology, Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, MD, USA.
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Gotay CC. Quality of life assessment in cancer clinical research: current status and a look to the future. Expert Rev Pharmacoecon Outcomes Res 2003; 3:479-86. [PMID: 19807458 DOI: 10.1586/14737167.3.4.479] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Quality of life (QOL) is a term that has been used to denote outcomes as experienced by the patient. Although definitions of QOL vary, virtually all investigators agree that QOL in clinically-ill individuals encompasses multiple domains or areas of well-being (including, at a minimum, physical, psychological and social functioning, as well as symptoms) and that the perspective of the patient is critical in any measurement of QOL. While patient perspectives are important in any health condition, they become particularly so in diseases which are chronic or incurable and for which treatments have toxic or long-lasting consequences. Cancer fits these criteria. Cancer is the second leading cause of death in the USA, with one in every four deaths due to the disease. Approximately 38% of cancer patients die within 5 years of diagnosis. Cancer treatments are powerful and toxic. For example, surgery removes tumors and in many cases, adjacent body parts. Radiation therapy kills cancer cells by directing high energy x-rays, electron beams or radioactive isotopes at tumors. Chemotherapy causes the death of cancer cells through the administration of agents that disrupt a cancer cell's growth cycle. All of these treatments affect normal tissue, as well as cancer cells, and generally result in multiple side effects, such as loss of hair, nausea and frequently vomiting which are associated with chemotherapy. Treatment-related effects may be short-term and time-limited, chronic and persistent or late that only emerge after therapy has been completed, sometimes many years later. Cancer therapy involves continual efforts to minimize side effects while at the same increasing the chances of surviving the disease. As such, patient perspectives become critical in evaluating whether or not therapies and their toxicities are tolerable and acceptable.
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Affiliation(s)
- Carolyn Cook Gotay
- Cancer Research Center of Hawaii, University of Hawaii, 1236 Lauhala St, Honolulu, HI 96813, USA.
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Larkey LK, Staten LK, Ritenbaugh C, Hall RA, Buller DB, Bassford T, Altimari BR. Recruitment of Hispanic women to the Women's Health Initiative. the case of Embajadoras in Arizona. CONTROLLED CLINICAL TRIALS 2002; 23:289-98. [PMID: 12057880 DOI: 10.1016/s0197-2456(02)00190-3] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This study examined the use of lay advocates (i.e., women enrolled in a study who advocate to others) to improve recruitment among Hispanic women in the Arizona recruitment sites for a large-scale, national prevention study, the Women's Health Initiative (WHI). We examined whether trained, Hispanic lay advocates (called Embajadoras) brought more women into the study than a matched group of Hispanic and Anglo enrollees in the WHI who were supplied with brochures. Fifty-six Hispanic participants in the WHI were randomized to receive training or no training on advocacy, and continued to meet quarterly for 18 months. Also, 42 Anglo women were assigned to control. All groups received brochures to use for advocating the WHI. The number of women referred and enrolled was tracked as well as other factors expected to influence outcomes. Embajadoras were more successful at referral and enrollment than untrained Hispanic women and more successful at enrollment than untrained Anglo controls. Embajadoras were also found to distribute significantly more brochures than control groups. Therefore, a culturally aligned training program to encourage current Hispanic participants in a clinical trial to advocate the study to others may be an effective way to boost referrals and enrollments. Other potential influences on enrollment or referral success could not be determined due to the small sample size. Further study is needed to examine the best methods to encourage enrollment for women referred to the study.
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Affiliation(s)
- Linda K Larkey
- Women's Cancer Prevention Office, Arizona Cancer Center, University of Arizona, Phoenix, AZ 85006, USA.
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Moinpour CM, Lyons B, Grevstad PK, Lovato LC, Crowley J, Czaplicki K, Buckner ZM, Ganz PA, Kelly K, Gandara DR. Quality of life in advanced non-small-cell lung cancer: results of a Southwest Oncology Group randomized trial. Qual Life Res 2002; 11:115-26. [PMID: 12018735 DOI: 10.1023/a:1015048908822] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
PURPOSE The main purpose of this paper is to present the results of a randomized trial comparing the effects of two chemotherapy regimens on the Quality of life (QOL) of patients with advanced non-small-cell lung cancer (NSCLC). Trials in advanced stage disease represent an important treatment context for QOL assessment. A second purpose of this paper is to examine methods for handling the level of missing data commonly observed in the advanced stage disease context. METHODS Patients were randomized to receive cisplatin plus vinorelbine or carboplatin plus paclitaxel. The QOL of 222 patients was assessed with the Functional Assessment of Cancer Therapy-Lung (FACT-L) prior to randomization; follow-up assessments occurred at 13 and 25 weeks. Three methods were used to analyze the QOL data: (1) cross-sectional analysis of four patient categories (improved, stable, missing, and declined) based on changes in the FACT-L score, (2) a mixed linear model, and (3) a pattern mixture model. The longitudinal analyses addressed two potential data biases. RESULTS Questionnaire submission rates were 91% at baseline, 68% at 13 weeks, and 47% at 25 weeks. The cross-sectional and mixed linear model analyses did not show significant differences by treatment arm in patient-reported QOL. The pattern mixture model analysis, more appropriate given non-ignorable missing data, also found no statistically significant effect of treatment on patient QOL. CONCLUSION We present a sensitivity analysis approach with multiple methods for analyzing treatment effects on patient QOL in the presence of substantial, non-ignorable missing data in an advanced stage disease clinical trial. We conclude that the two treatment arms did not differ statistically in their effects on patient QOL over a 25-week treatment period.
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Affiliation(s)
- C M Moinpour
- Southwest Oncology Group Statistical Center, Fred Hutchinson Cancer Research Center, Seattle, WA 98109-1024, USA.
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Abstract
Readers of medical literature need to consider two types of validity, internal and external. Internal validity means that the study measured what it set out to; external validity is the ability to generalise from the study to the reader's patients. With respect to internal validity, selection bias, information bias, and confounding are present to some degree in all observational research. Selection bias stems from an absence of comparability between groups being studied. Information bias results from incorrect determination of exposure, outcome, or both. The effect of information bias depends on its type. If information is gathered differently for one group than for another, bias results. By contrast, non-differential misclassification tends to obscure real differences. Confounding is a mixing or blurring of effects: a researcher attempts to relate an exposure to an outcome but actually measures the effect of a third factor (the confounding variable). Confounding can be controlled in several ways: restriction, matching, stratification, and more sophisticated multivariate techniques. If a reader cannot explain away study results on the basis of selection, information, or confounding bias, then chance might be another explanation. Chance should be examined last, however, since these biases can account for highly significant, though bogus results. Differentiation between spurious, indirect, and causal associations can be difficult. Criteria such as temporal sequence, strength and consistency of an association, and evidence of a dose-response effect lend support to a causal link.
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Affiliation(s)
- David A Grimes
- Family Health International, PO Box 13950, Research Triangle Park, NC 27709, USA.
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Brown ML, Lipscomb J, Snyder C. The burden of illness of cancer: economic cost and quality of life. Annu Rev Public Health 2001; 22:91-113. [PMID: 11274513 DOI: 10.1146/annurev.publhealth.22.1.91] [Citation(s) in RCA: 190] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Cancer is a major public health issue and represents a significant burden of disease. In this chapter, we analyze the main measures of burden of disease as relate to cancer. Specifically, we review incidence and mortality, years of life lost from cancer, and cancer prevalence. We also discuss the economic burden of cancer, including cost of illness, phase-specific and long-term costs, and indirect costs. We then examine the impact of cancer on health-related quality of life as measured in global terms (disability-adjusted life years and quality-adjusted life years) and using evaluation-oriented applications of health-related quality of life scales. Throughout, we note the relative strengths and weaknesses of the various approaches to measuring the burden of cancer as well as the methodologic challenges that persist in burden-of-illness research. We conclude with a discussion of the research agenda to improve our understanding of the burden of cancer and of illness more generally.
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Affiliation(s)
- M L Brown
- Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland 20892, USA.
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Abstract
OBJECTIVES To provide a review of prostate cancer epidemiology. DATA SOURCES Journal articles and the Surveillance, Epidemiology, and End Results database. CONCLUSIONS Numerous risk factors for prostate cancer have been identified. Incidence and mortality rates are higher in certain countries and among racial ethnic groups. Environmental and dietary influences are likely to be significant causes of prostate cancer. Distinguishing those cancers that are clinically significant from those that are not remains a central concern in prostate cancer research. IMPLICATIONS FOR NURSING PRACTICE Knowledge of epidemiologic patterns and trends will assist nurses in recognising persons at high risk for the development of prostate cancer and should result in tailored educational interventions.
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Affiliation(s)
- O W Brawley
- Office of Special Populations Research, National Cancer Institute/National Institute of Health, 6120 Executive Blvd, Executive Plaza South, Suite 320, Rockville, MD 20852, USA
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Affiliation(s)
- C Nabhan
- Division of Hematology/Oncology, Northwestern University Medical School, 676 N. St. Clair, Suite 850, Chicago, IL 60611, USA
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Lee JJ, Lieberman R, Sloan JA, Piantadosi S, Lippman SM. Design considerations for efficient prostate cancer chemoprevention trials. Urology 2001; 57:205-12. [PMID: 11295629 DOI: 10.1016/s0090-4295(00)00976-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Prostate cancer, even with its substantial public health impact of 180,400 new cases and 31,900 deaths estimated for 2000, still has a very low annual incidence (0.27% for men 34.4 years and older), which makes designing and conducting efficient prostate cancer prevention trials a challenge. Definitive prevention trials with cancer endpoints, such as the Breast Cancer Prevention Trial (BCPT), Prostate Cancer Prevention Trial (PCPT), and Selenium and Vitamin E Cancer Prevention Trial (SELECT), require long trial duration (up to 12 years) and large sample size (up to 32,400 subjects) to accomplish their objectives. This article discusses design concepts for potential prostate cancer prevention trials that require fewer years, subjects, and resources to complete. Design elements, such as high-risk populations, randomization, surrogate endpoints, including quality-of-life endpoints, masking/blinding, and various clinical/statistical designs (including 1-way layout, all-versus-none, factorial, and adaptive designs), are discussed, along with the ultimate goal of gaining US Food and Drug Administration approval for prostate-cancer preventive agents that can improve public health by reducing prostate cancer incidence and mortality.
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Affiliation(s)
- J J Lee
- Departments of Biostatistics The University of Texas M.D. Anderson Cancer Center, Houston, Texas 77030, USA.
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