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Baydoun A, Sun Y, Jia AY, Zaorsky NG, Shoag JE, Vince RA, Ponsky L, Barata P, Garcia J, Berlin A, Ramotar M, Finelli A, Wallis CJD, van der Kwast T, Spratt DE. Post-Prostatectomy Risk Stratification of Biochemical Recurrence Using Transfer Learning-Based Multi-Modal Artificial Intelligence. Int J Radiat Oncol Biol Phys 2023; 117:S83-S84. [PMID: 37784586 DOI: 10.1016/j.ijrobp.2023.06.404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) For patients undergoing radical prostatectomy for prostate cancer (PCa), accurate risk stratification is essential to guide post-prostatectomy therapeutic decision making. Recently, there has been success in the use of multi-modal artificial intelligence models for men after prostate biopsy to aid in risk stratification. Herein, we trained and tested a TRansfer learning-based multi-modal Artificial InteLligence model (TRAIL) for biochemical recurrence (BCR) risk stratification following radical prostatectomy. MATERIALS/METHODS Patients contained within a prospective PCa registry at a single institution were utilized. Digital pathology slides from the diagnostic biopsies prior to radical prostatectomy for patients with clinically localized PCa were scanned at 20x resolution. Features were extracted for the TRAIL model from pathology slides via two transfer learning steps: (1) InceptionResNetv2 that first determines a heatmap of tumor areas, and (2) A ResNet18 that extracts representative features from the high tumor probability areas. Least Absolute Shrinkage and Selection Operator (LASSO) was used for feature selection from the pathology-extracted features. Finally, TRAIL combines the clinical and pathology-extracted features via a classification ensemble model based on weak tree learners to predict 2- and 5-year BCR defined as two consecutive serum PSA levels ≥0.2 ng/mL. TRAIL training was performed on 250 patients and was then locked and applied to the test set of 125 patients. Accuracy and the area under the curve (AUC) were calculated. Comparison to CAPRA-S and to clinical-only features were assessed. RESULTS A total of 818 digital whole pathology biopsy slides from 375 patients treated with subsequent radical prostatectomy were included. Surgical margins were positive in 29% of the patients, and 41% had extra-prostatic extension. The median follow-up was 48 months (Range: 1-132 months). The rates of 2-and 5-year BCR were 11% and 18% respectively. A total of 19 digital pathology-driven features were included in TRAIL. Clinical factors included age, ISUPG, Gleason score, PSA, pathological T and N stages, surgical margin involvement, and the presence of extra-prostatic extension. On the testing set, TRAIL achieved a 2-year BCR AUC of 0.76 and accuracy of 0.87, and was superior to CAPRA-S (AUC = 0.57) and clinical-only features (AUC 0.50, accuracy 0.14). For 5-year BCR, TRAIL achieved an AUC of 0.69 and accuracy of 0.78, and performed better than CAPRA-S (AUC = 0.58), and clinical only features (AUC = 0.50, accuracy = 0.23). CONCLUSION Through a combination of deep and ensemble learning, TRAIL incorporates clinical and histopathology features, enabling an improved BCR risk stratification post-prostatectomy when compared to the currently used clinicopathologic models. Future work with larger datasets with metastatic events is warranted to further optimize the model for clinical use.
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Affiliation(s)
- A Baydoun
- University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH
| | - Y Sun
- University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH
| | - A Y Jia
- University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH
| | - N G Zaorsky
- University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH
| | - J E Shoag
- University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH
| | - R A Vince
- University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH
| | - L Ponsky
- Urology, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - P Barata
- University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH
| | - J Garcia
- University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH
| | - A Berlin
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - M Ramotar
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - A Finelli
- Department of Surgical Oncology, Division of Urology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - C J D Wallis
- Mount Sinai Hospital, UHN, University of Toronto, Toronto, ON, Canada
| | | | - D E Spratt
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center and Case Western Reserve University, Cleveland, OH
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Jia AY, Sun Y, Baydoun A, Zaorsky NG, Vince RA, Shoag JE, Brown J, Barata P, Dess RT, Jackson WC, Roy S, Nguyen PL, Berlin A, Mehra R, Schaeffer EM, Kashani R, Kishan AU, Morgan TM, Spratt DE. Cross-Comparison Individual Patient Level Analysis of Three Gene Expression Signatures in Localized Prostate in over 50,000 Men. Int J Radiat Oncol Biol Phys 2023; 117:S35. [PMID: 37784481 DOI: 10.1016/j.ijrobp.2023.06.301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Risk stratification guides the management of localized prostate cancer. Multiple commercial gene expression biomarkers have been developed to improve estimates of prognosis, however the 22-gene Decipher genomic classifier (22-GC) is the only test with level 1 evidence supporting its use per NCCN guidelines. It is unknown whether other commercial signatures, Oncotype (GPS) or Prolaris (CCP), are sufficiently correlated to negate the differences in evidence supporting these commercial tests. Herein, we aim to perform a cross-comparison of these signatures in a large cohort of patients diagnosed with localized prostate cancer. MATERIALS/METHODS Patients diagnosed with localized prostate cancer who underwent whole transcriptome gene expression microarray analysis on their primary tumor biopsy specimen were included. The 22-GC score was calculated by Veracyte using a commercially locked model. Individual genes in each of the GPS and CCP gene signatures were identified, and the gene weights in each signature were retrained for prediction of metastasis in a multi-institutional cohort of 1,574 men with long-term outcome data. This was performed to improve correlation performance of GPS and CCP given only the 22-GC was trained for prediction of metastasis. For each of the three signatures, both continuous and categorical scores were calculated. Linear regression and spearman correlations were calculated both on univariable and multivariable analyses adjusting for age, grade group, PSA, and T-stage. RESULTS A total of 50,881 patients were included (15,379 (30.2%) NCCN low-risk, 14,773 (29.0%) favorable intermediate-risk, 15,544 (30.5%) unfavorable intermediate-risk, and 5,185 (10.2%) high/very high-risk) with a median age of 68 years, and a median PSA of 6.2 ng/mL. On linear regression, the GPS model had poor goodness-of-fit to the 22-GC with an R2 of 0.36, as did the CCP model to the 22-GC with an R2 of 0.32. For CCP, the linear sum of the 31-genes was also tested but had inferior performance (R2 0.28) compared to the reoptimized CCP model. Results were similar on multivariable analysis adjusting for age, PSA, clinical stage and grade group. Spearman correlation between the continuous GPS model scores and the 22-GC was moderate at 0.59, as was the correlation between CCP model and the 22-GC of 0.54. CCP is a measure of proliferation, but in 22-GC high-risk patients, the majority (64.1%) of patients had low-average proliferation and only 35.9% had high proliferation, potentially explaining the lack of strong correlation. CONCLUSION There is minimal to moderate correlation between the 22-GC and GPS or CCP gene expression signatures tested. Therefore, these tests should not be viewed as interchangeable, and utilization should be based on the level of evidence supporting each gene expression biomarker.
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Affiliation(s)
- A Y Jia
- University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH
| | - Y Sun
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
| | - A Baydoun
- University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH
| | - N G Zaorsky
- University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH
| | - R A Vince
- University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH
| | - J E Shoag
- University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH
| | - J Brown
- University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH
| | - P Barata
- University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, OH
| | - R T Dess
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
| | - W C Jackson
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
| | - S Roy
- Rush University Medical Centre, Chicago, IL
| | - P L Nguyen
- Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, MA
| | - A Berlin
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - R Mehra
- Department of Pathology, University of Michigan, Ann Arbor, MI
| | | | - R Kashani
- 4921 Parkview Place, Saint Louis, MO
| | - A U Kishan
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA
| | - T M Morgan
- Department of Urology, University of Michigan, Ann Arbor, MI
| | - D E Spratt
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center and Case Western Reserve University, Cleveland, OH
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Gutierrez E, Navarro I, Chow R, Zhou K, Ramotar M, Sanchez-Rodriguez IE, Ruiz V, Weersink RA, Glicksman R, Helou J, Berlin A, Chung P, Raman S, Fazelzad R. Focal Brachytherapy for Localized Prostate Cancer: Systematic Review and Meta-Analysis. Int J Radiat Oncol Biol Phys 2023; 117:e388. [PMID: 37785306 DOI: 10.1016/j.ijrobp.2023.06.2509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Advances in image-guided brachytherapy have increased the interest in focal brachytherapy (F-BT) approaches to optimize disease control, while reducing the toxicities associated whole gland treatments for prostate cancer (PCa). In this study we performed a systematic review to report biochemical control (BC), and genitourinary (GU) and gastrointestinal (GI) toxicity rates in patients with localized prostate cancer treated with F-BT as a definitive or salvage modality. MATERIALS/METHODS This project was registered in the PROSPERO database (ID CRD42022320921). A comprehensive literature search was conducted in Cochrane Central databases, Cochrane Database of Systematic Reviews, Embase Classic +Embase, and Medline ALL, all from the OvidSP platform and Web of Science from Clarivate, from each database's inception to July 2022. Search was restricted to English and included terms: focal brachytherapy/prostate cancer, partial brachytherapy/prostate cancer. In total, 14862 articles were identified. Manuscripts that not related to focal or partial prostate brachytherapy, review papers and studies not reporting BC were excluded. After eliminating duplicates, and studies deemed irrelevant by consensus among three independent reviewers, 44 articles remained for in-depth review and data extraction. RESULTS Thirty studies that included BC outcomes were included for this analysis, comprising 1556 patients treated with F-BT for PCa. Of these, 1094 (70%) and 462 (30%) underwent F-BT as definitive monotherapy or salvage, respectively; while 585 (38%) and 971 (62%) received HDR or LDR, respectively. For F-BT as monotherapy, the most commonly prescribed dose for HDR was 19 Gy in 1 fraction (range 19-24 Gy), and for LDR, 145 Gy (90-160Gy). Whereas for salvage F-BT, most common dose schedule of HDR was 19Gy in 1 fraction (19-27GY) and LDR 145Gy (144-145Gy). BC random effects estimate for F-BT monotherapy at 1-, 2-, 3-, and 5-years were 100% (P = 1.0), 96% (P = 0.45), 91% (P = 0.45) and 87% (P< 0.01), respectively. Whereas BC random effects estimate for salvage at 1-, 2-, 3-, and 5-years were 91% (P = 0.86), 68% (0.17), and 57% (P = 0.20), respectively. GI and GU grade 3-4 crude toxicity rates for monotherapy and salvage ranged from 0-3.33% and 0-17%, respectively. CONCLUSION Over the last decade, there has been increasing interest in F-BT approaches, both as monotherapy and in the salvage setting. BC and toxicity profiles of F-BT appear favorable, and future studies directly comparing with whole-gland treatments are warranted.
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Affiliation(s)
- E Gutierrez
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - I Navarro
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - R Chow
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - K Zhou
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - M Ramotar
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | | | - V Ruiz
- University of Guadalajara, Guadalajara, Mexico
| | - R A Weersink
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - R Glicksman
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - J Helou
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - A Berlin
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - P Chung
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - S Raman
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - R Fazelzad
- Library and Information Services, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
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4
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Zhong AY, Lui AJ, Katz MS, Berlin A, Kamran SC, Kishan AU, Murthy V, Nagar H, Seible DM, Stish BJ, Tree A, Seibert TM. Use of Focal Radiotherapy Boost for Prostate Cancer and Perceived Barriers toward its Implementation: A Survey. Int J Radiat Oncol Biol Phys 2023; 117:e454-e455. [PMID: 37785459 DOI: 10.1016/j.ijrobp.2023.06.1643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) In a recent phase III randomized control trial (FLAME), delivering a focal radiotherapy (RT) boost to tumors visible on MRI was shown to improve outcomes for prostate cancer patients without increasing toxicity. The aim of this study was to assess how widely this technique is being applied in current practices worldwide as well as physicians' perceived barriers toward its implementation. MATERIALS/METHODS An online survey assessing the use of intraprostatic focal boost was conducted in December 2022 and February 2023. The survey link was distributed to radiation oncologists worldwide via email list, group text platform, and social media. Survey questions included how many prostate cancer cases participants treat in a typical month; how often they use focal boost, if at all; the degree to which their practice is genitourinary (GU)-subspecialized; main barriers to implementing focal boost more often in their practice; and demographic information. Subgroup analyses were also conducted for participants from high-income or low-to-middle-income countries, as defined by the World Bank. RESULTS The survey initially collected 205 responses from various countries over a two-week period in December 2022. The survey was then reopened for one week in February 2023 to allow for more participation, leading to a total of 263 responses. The highest-represented countries were the United States (42%), Mexico (13%), and the United Kingdom (8%). The majority of respondents worked at an academic medical center (52%) and considered their practice to be at least partially GU-subspecialized (74%). 57% of participants overall reported not routinely using intraprostatic focal boost. Even among complete subspecialists, a substantial proportion (39%) do not routinely use focal boost. Less than half of participants in both high-income and low-to-middle-income countries were shown to routinely use focal boost. Perceived barriers to implementation are shown in Table 1. CONCLUSION Despite the promising level 1 results of the FLAME trial, many radiation oncologists worldwide are not routinely offering focal RT boost. Adoption of this technique might be accelerated by increased access to high-quality MRI, better registration algorithms of MRI to CT simulation images, physician education on benefit-to-harm ratio, automated planning algorithms, and physician training on contouring prostate lesions on MRI.
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Affiliation(s)
- A Y Zhong
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA
| | - A J Lui
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA
| | - M S Katz
- Radiation Oncology Associates, Lowell, MA
| | - A Berlin
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - S C Kamran
- Massachusetts General Hospital, Boston, MA
| | - A U Kishan
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA
| | - V Murthy
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - H Nagar
- Department of Radiation Oncology, New York-Presbyterian/Weill Cornell Hospital, New York, NY
| | - D M Seible
- Anchorage & Valley Radiation Therapy Centers, Anchorage, AK
| | - B J Stish
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - A Tree
- Radiotherapy and Imaging Division, Institute of Cancer Research, London, United Kingdom
| | - T M Seibert
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA; Department of Radiology, University of California San Diego, La Jolla, CA
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5
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Johnny C, Berlin A, Weersink RA, Raman S, Glicksman R, Catton C, Rink A, Warde PR, Lao B, Menard C, Chung P. MR-Guided HDR Brachytherapy Boost in Localized Prostate Cancer - Results of a Phase II Trial. Int J Radiat Oncol Biol Phys 2023; 117:e397. [PMID: 37785327 DOI: 10.1016/j.ijrobp.2023.06.1525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Dose escalation in localized prostate cancer using brachytherapy combined with external beam radiation (EBRT) has demonstrated improved biochemical control compared to EBRT alone. However, ultrasound guided LDR brachytherapy might be associated with increased GU toxicity. We report the results of a prospective study of MR-guided HDR brachytherapy (MRgHDR) in combination with EBRT for localized prostate cancer. MATERIALS/METHODS Intermediate- (IR) and high-risk (HR) prostate cancer patients were eligible. Patients received either 15Gy single fraction or 10Gy x 2 fractions using MRgHDR technique, followed by EBRT (37.5 Gy, [prostate only] -IR or 45-46 Gy - [prostate + pelvic nodes] -HR). Toxicity (CTCAE v4) and HRQoL (EPIC) were recorded at 1, 3 and 6 months, then at 1, 2, 3, and 5 years. Androgen deprivation therapy (ADT) was used according to the appropriate disease risk category. Biochemical failure was defined according to Phoenix definition (nadir+2). RESULTS From 2010-2018, 120 patients were enrolled, 53 (44%) had IR and 67 (56%) had HR disease. Median age was 69 years (range, 46-78), median PSA was 12.1 ng/ml (3.2-148). ADT was used in 84 (70%) of patients, of whom 51 (60%) patients received <1 year and 33 (40%) received >1 year of ADT. A single fraction of 15Gy was given to 94 patients (78%) and the remaining 26 patients (22%) received 10Gy x 2 fractions. EBRT dose was 37.5Gy in 52 (43%) patients while 67 (56%) received 45-46Gy. One patient received only the first fraction of 10Gy, declined the second fraction and subsequently received 60Gy EBRT to the prostate. The median follow up was 58 months (11-134). Overall, 5-year biochemical control was 90% while it was 95% and 86% for IR and HR, respectively. At 5 years 7% patient had nodal or distant relapse or both. While the 5-yr distant control rates were 95% and 91% in the IR, HR, respectively. Acute grade ≥2 GU and GI toxicity was 6.7% and 5% respectively. Acute toxicity trended back to baseline by 6 months in all patients except one. Late grade ≥ 2 GU and GI worst toxicity was seen in 10% and 4.2%, respectively. As with acute toxicity, late toxicity tended to improve over time. Only one patient experienced severe toxicity (Grade 3 GU - frequency) at 6 months but subsequently this resolved. HRQol will be reported separately. CONCLUSION MRgHDR brachytherapy boost in conjunction with EBRT provides comparable biochemical outcomes compared to the literature. Severe toxicity rates were minimal. Further follow-up will determine if these outcomes are sustained.
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Affiliation(s)
- C Johnny
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - A Berlin
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - R A Weersink
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - S Raman
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - R Glicksman
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - C Catton
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - A Rink
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Canada, Toronto, ON, Canada
| | - P R Warde
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - B Lao
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - C Menard
- Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada
| | - P Chung
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
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6
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Sutera P, Deek MP, Jing Y, Pryor DI, Huynh MA, Koontz BF, Mercier C, Ost P, Kiess AP, Conde-Moreno AJ, Stish BJ, Bosetti DG, Siva S, Berlin A, Kroeze S, Corcoran N, Trock B, Gillessen S, Tran PT, Sweeney C. Multi-Institutional Analysis of Metastasis Directed Therapy with or without Androgen Deprivation Therapy in Oligometastatic Castration Sensitive Prostate Cancer. Int J Radiat Oncol Biol Phys 2023; 117:e442-e443. [PMID: 37785433 DOI: 10.1016/j.ijrobp.2023.06.1620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Several prospective trials in oligometastatic castration sensitive prostate cancer (omCSPC) have shown metastasis-directed therapy (MDT) can delay time to progression and initiation of androgen deprivation therapy (ADT) compared to observation. However, the optimal integration of ADT with MDT remains unclear. Here we report a multi-national, multi-institutional retrospective cohort of omCSPC treated with MDT to characterize the long-term outcomes of patients treated with MDT alone or in combination with ADT. MATERIALS/METHODS Patients with a controlled primary site and omCSPC (defined as ≤ 5 lesions on conventional imaging) treated with MDT with or without concurrent ADT and with at least 36 months follow-up were retrospectively screened across 13 institutions. The primary endpoints included biochemical progression free survival (bPFS) and radiographic progression free survival (rPFS) calculated using Kaplan-Meier method and stratified by treatment group (MDT alone vs MDT + ADT). Multivariable Cox regression was performed adjusted for variables found to be prognostic on univariate analysis. RESULTS Among 414 patients screened, a total of 263 patients treated between 2003 and 2018 met inclusion criteria and included. Of these, 105 received MDT alone and 158 received MDT+ADT, with median follow-up of 49.5 and 54.5 months, respectively. The majority were metachronous (90%) and had bone lesions (60%). Median ADT duration was 21.3 months (IQR 12.0- 31.9). Patients who received ADT vs. no ADT had poorer prognostic features including 23% vs. 1% synchronous (p<0.001), and 55% vs 40% Gleason 8-10 (p = 0.012). ADT use was associated with a better 5-year bPFS 24% vs 11% (p<0.0001) and rPFS 41% vs 29% (p<0.001). On multivariable Cox regression adjusting for post-MDT PSA nadir and salvage therapy, ADT use maintained significance for both bPFS (HR 0.51 (0.36, 0.71), p<0.001) and rPFS (HR 0.67, 95% CI 0.46-0.96, p = 0.03). CONCLUSION Long-term outcomes with MDT alone suggest a small proportion of patients experience sustained disease control. The addition of ADT appears to improve rPFS, however prospective studies are needed in order to allow for personalization of care in patients with omCSPC.
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Affiliation(s)
- P Sutera
- Johns Hopkins University School of Medicine, Baltimore, MD
| | - M P Deek
- Rutgers Cancer Institute of New Jersey, Department of Radiation Oncology, New Brunswick, NJ
| | - Y Jing
- Johns Hopkins, Baltimore, MD
| | - D I Pryor
- Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - M A Huynh
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA
| | | | - C Mercier
- Gasthuis Sisters, Antwerpen, Belgium
| | - P Ost
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - A P Kiess
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - B J Stish
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - D G Bosetti
- Department of Radiation Oncology, Istituto Oncologico della Svizzera Italiana, Bellinzona, Switzerland
| | - S Siva
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
| | - A Berlin
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - S Kroeze
- University Hospital Zurich, Zurich, Switzerland
| | - N Corcoran
- University of Melbourne, Melbourne, Australia
| | - B Trock
- Brady Urological Institute at Johns Hopkins Medical Institution, Baltimore, MD
| | - S Gillessen
- Istituto Oncologico della Svizzera Italiana, Bellinzona, Switzerland
| | - P T Tran
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD
| | - C Sweeney
- University of Adelaide, Adelaide, Australia
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7
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Nakagawa S, Callahan ME, Berlin A. Patient Values: Three Important Questions-Tell me more? Why? What else? BMJ Support Palliat Care 2023; 13:363-364. [PMID: 37076260 DOI: 10.1136/spcare-2023-004302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 04/04/2023] [Indexed: 04/21/2023]
Affiliation(s)
- Shunichi Nakagawa
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Mary E Callahan
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Ana Berlin
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
- Department of Surgery, Columbia University Irving Medical Center, New York, NY, USA
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8
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Waring NA, Yang ES, Berlin A, Shim JK. Palliative care in a rural surgery residency program: an educational needs assessment. Ann Palliat Med 2023; 12:686-696. [PMID: 37038061 DOI: 10.21037/apm-22-1369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 03/21/2023] [Indexed: 04/12/2023]
Abstract
BACKGROUND There is a deficiency of palliative care education in surgical residency programs and a lack of research on palliative care education in rural surgery residency programs. Because rural palliative care presents unique challenges due to fewer specialists and resources, we investigated potential areas of improvement in palliative care education in a rural general surgery residency program. METHODS An anonymous survey was sent to all residents of a rural general surgery residency program. The survey assessed prior hospice/palliative care education in medical school, prior volunteering experience in palliative care, comfort with having "goals of care" discussions and delivering serious news, and perceived indications for palliative care consultation. A follow-up survey assessed attitudes and interest related to palliative care education integration in a rural surgical residency program. RESULTS Of 17 residents, 14 (82.4%) responded to the initial survey. Four respondents (28.6%) had over a half day of palliative care education in medical school. Eight of fourteen respondents (57.1%) feel comfortable having "goals of care" discussions: 0/4 interns (0%) compared to 8/10 junior and senior residents (80%). Half of respondents feel comfortable delivering serious news: 1/4 interns (25%) compared to 6/10 junior and senior residents (60%). All respondents agreed that palliative care education is necessary. Four themes were identified in content analysis of perceived indications for palliative care consultation: future planning, deferring to the expert, patient/family education, and surgeon/trainee discomfort. The follow-up survey revealed perceived limitations in palliative care resources available in a rural surgery setting. CONCLUSIONS These results highlight the need for formal palliative care education in a rural surgery residency program. Throughout training, residents appear to develop more comfort with "goals of care" discussions than delivering serious news. In response, we are instituting palliative care discussions during educational conference, including interactive simulations to improve communication skills, and a palliative care telemedicine elective.
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Affiliation(s)
- Nicholas A Waring
- Columbia-Bassett Program, Vagelos College of Physicians & Surgeons, Columbia University, New York, NY, USA
| | - Eunice S Yang
- Department of Surgery, Bassett Medical Center, Cooperstown, NY, USA
| | - Ana Berlin
- Department of Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Joon K Shim
- Department of Surgery, Bassett Medical Center, Cooperstown, NY, USA
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Romanenko A, Harnik R, Grassellino A, Pilipenko R, Pischalnikov Y, Liu Z, Melnychuk OS, Giaccone B, Pronitchev O, Khabiboulline T, Frolov D, Posen S, Belomestnykh S, Berlin A, Hook A. Search for Dark Photons with Superconducting Radio Frequency Cavities. Phys Rev Lett 2023; 130:261801. [PMID: 37450797 DOI: 10.1103/physrevlett.130.261801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 05/23/2023] [Indexed: 07/18/2023]
Abstract
We conduct the first "light-shining-through-wall" (LSW) search for dark photons using two state-of-the-art high-quality-factor superconducting radio frequency (SRF) cavities -Dark SRF-and report the results of its pathfinder run. Our new experimental setup enables improvements in sensitivity over previous searches and covers new dark photon parameter space. We design delicate calibration and measurement protocols to utilize the high-Q setup at Dark SRF. Using cavities operating at 1.3 GHz, we establish a new exclusion limit for kinetic mixing as small as ε=1.6×10^{-9} and provide the world's best constraints on dark photons in the 2.1×10^{-7}-5.7×10^{-6} eV mass range. Our result is the first proof of concept for the enabling role of SRF cavities in LSW setups, with ample opportunities for further improvements. In addition, our data set a competitive lab-based limit on the standard model photon mass by searching for longitudinal photon polarization.
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Affiliation(s)
- A Romanenko
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - R Harnik
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - A Grassellino
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - R Pilipenko
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - Y Pischalnikov
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - Z Liu
- School of Physics and Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - O S Melnychuk
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - B Giaccone
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - O Pronitchev
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - T Khabiboulline
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - D Frolov
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - S Posen
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - S Belomestnykh
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - A Berlin
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - A Hook
- Maryland Center for Fundamental Physics, University of Maryland, College Park, Maryland 20742, USA
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Sanmamed N, Locke G, Crook J, Liu A, Raman S, Glicksman R, Chung P, Berlin A, Fleshner N, Helou J. Long-Term Biochemical Control of a Prospective Cohort of Prostate Cancer Patients Treated With Interstitial Brachytherapy Versus Radical Prostatectomy. Clin Oncol (R Coll Radiol) 2023; 35:262-268. [PMID: 36737311 DOI: 10.1016/j.clon.2023.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 12/05/2022] [Accepted: 01/12/2023] [Indexed: 01/22/2023]
Abstract
AIMS To report long-term oncological outcomes of men treated prospectively as part of the American College of Surgeons Oncology Group phase III Surgical Prostatectomy Versus Interstitial Radiation Intervention Trial (SPIRIT) at our institution. MATERIALS AND METHODS In 2003-2004, patients eligible for SPRIT attended a multidisciplinary educational session, following which they could choose radical prostatectomy, low dose rate brachytherapy (LDR-BT) or randomisation to SPIRIT. Biochemical failure was determined by the accepted definitions of a prostate-specific antigen (PSA) level ≥0.2 ng/ml after radical prostatectomy and the Phoenix definition of PSA ≥2 ng/ml above the nadir after LDR-BT. A sensitivity analysis, using a PSA >0.5 ng/ml to define biochemical failure after LDR-BT and a threshold PSA ≥0.2 ng/ml, was carried out to test the robustness of the results. To account for the competing risk of death, Gray's test was used to test the equality of the cumulative incidence function of biochemical failure between treatment groups. The Kaplan-Meier method was used to estimate overall survival and prostate cancer-specific survival. A P-value ≤0.05 was considered statistically significant. RESULTS Of 156 patients, 100 received LDR-BT (15 after randomisation) and 56 underwent radical prostatectomy (15 after randomisation). The median follow-up was 12.6 and 14.7 years for LDR-BT and radical prostatectomy, respectively. The median age was 60 years; the median pre-treatment PSA was 5.5 (interquartile range 4.3-7.1). No significant differences in patient characteristics were found between groups. Two patients received adjuvant radiotherapy after radical prostatectomy. The cumulative incidence function of biochemical failure was 0%, 1.1% and 2.4% at 5, 10 and 15 years, respectively, in the LDR-BT arm versus 8.5%, 15.8% and 15.8% in the radical prostatectomy arm (P < 0.001). These results were consistent when varying the definition of biochemical failure defined as PSA ≥0.5 ng/ml (P = 0.01). At 15 years, overall survival was higher in patients treated with radical prostatectomy compared with those treated with LDR-BT; however, no statistical difference was found in prostate cancer-specific survival. CONCLUSION In low-risk prostate cancer patients, LDR-BT offers excellent long-term oncological outcomes comparable with radical prostatectomy, in addition to the previously reported advantage for LDR-BT in urinary and sexual quality of life domains and patient satisfaction.
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Affiliation(s)
- N Sanmamed
- Department of Radiation Oncology, Hospital Clinico San Carlos, Madrid, Spain; Investigation Institute, Clinico San Carlos Hospital, Madrid, Spain
| | - G Locke
- Department of Radiation Oncology, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - J Crook
- BC Cancer and University of British Columbia, Kelowna, British Columbia, Canada
| | - A Liu
- Department of Statistics, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - S Raman
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - R Glicksman
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - P Chung
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - A Berlin
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada; TECHNA Institute, University of Toronto, Toronto, Ontario, Canada
| | - N Fleshner
- Division of Urology, Department of Surgical Oncology, University Health Network, Toronto, Ontario, Canada
| | - J Helou
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada.
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Coleman N, Spoozak L, McCammon SD, Cooper Z, Arnell T, Berlin A. Promoting Specialty Diversity in Hospice and Palliative Medicine: A Call to Action. J Pain Symptom Manage 2023; 65:151-154. [PMID: 36775535 DOI: 10.1016/j.jpainsymman.2022.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 11/11/2022] [Indexed: 01/11/2023]
Affiliation(s)
- Natasha Coleman
- Department of Surgery (N.C., L.S.), Columbia University Irving Medical Center, New York, New York, USA; Division of Gynecologic Oncology (N.C.), Department of Obstetrics and Gynecology, University of Kansas Cancer Center
| | - Lori Spoozak
- Department of Surgery (N.C., L.S.), Columbia University Irving Medical Center, New York, New York, USA; Palliative Medicine Division (L.S.), Department of Internal Medicine, University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Susan D McCammon
- Pat and Jean Sullivan Comprehensive Head and Neck Cancer Survivorship Clinic (S.D.M.), Head and Neck Surgical Oncology and Microvascular Reconstruction Fellowship, UAB Clinical Ethics Program, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Zara Cooper
- Harvard Medical Scool (Z.C.), Kessler Director Center for Surgery and Public Health Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Tracey Arnell
- Division of General Surgery (T.A.), Department of Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Ana Berlin
- Division of General Surgery (A.B.), Department of Surgery and Division of Palliative Care, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA.
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12
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Coleman NL, Berlin A, Fischkoff K, Lee-Kong SA, Blinderman CD, Nakagawa S. Annual Structured Communication Skills Training for Surgery Residents. J Surg Res 2023; 281:314-320. [PMID: 36228342 DOI: 10.1016/j.jss.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 08/11/2022] [Accepted: 09/15/2022] [Indexed: 11/05/2022]
Abstract
INTRODUCTION There is no formalized communication curriculum for surgical training. The aim of this study is to determine the benefit of annual communication skill-building workshops for surgical residents over several years. METHODS The general surgery and the integrated cardiothoracic surgery residents in a tertiary care, urban academic center participated in a 2-hour communication skill-building workshop each year from July 2017 to June 2021. Each participant was administered an anonymous pre-session and post-session survey with a 5-point Likert scale to assess their self-reported preparedness and their evaluation of the workshop. Survey responses were divided into three groups based on their experience in this workshop; no experience (Experience 0), 1 y of experience (Experience 1), and two or more years of experience (Experience 2+). They were compared among groups. RESULTS Seventy-one surgical residents participated in the workshop generating 124 survey results (Experience 0, 71 [57.3%], Experience 1, 41 [33.1%], and Experience 2+, 12 [9.7%]). Self-reported preparedness scores improved for the overall group as well as for each experience group. While scores decreased significantly in the following years, they improved after each workshop. Scores were significantly better with more experience (4, interquartile range [IQR] 3-4 in Experience 0, 4, IQR 3-5 in Experience 1, 4, IQR 4-5 in Experience 2+, P < 0.001 between Experience 0 and Experience 1, P = 0.041 between Experience 1 and Experience 2+). All residents reported an overwhelmingly positive review of the curriculum. CONCLUSIONS Yearly 2-hour communication skills practice increased surgical residents' self-reported preparedness, and the repetition helped the improvement. Annual workshops are important for residents to be more prepared for serious illness communication.
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Affiliation(s)
- Natasha L Coleman
- Department of Surgery, Division of General Surgery, Columbia University Irving Medical Center, New York, New York
| | - Ana Berlin
- Department of Surgery, Division of General Surgery, Columbia University Irving Medical Center, New York, New York; Department of Medicine, Adult Palliative Care Services, Columbia University Irving Medical Center, New York, New York
| | - Katherine Fischkoff
- Department of Surgery, Division of General Surgery, Columbia University Irving Medical Center, New York, New York
| | - Steven A Lee-Kong
- Department of Surgery, Division of General Surgery, Columbia University Irving Medical Center, New York, New York
| | - Craig D Blinderman
- Department of Medicine, Adult Palliative Care Services, Columbia University Irving Medical Center, New York, New York
| | - Shunichi Nakagawa
- Department of Medicine, Adult Palliative Care Services, Columbia University Irving Medical Center, New York, New York.
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13
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Huber MT, Ling DY, Rozen AS, Terauchi SY, Sharma P, Fleischer-Black J, Schoenherr LA, Hutchinson RN, Lindvall C, Jones CA, Guerry RT, Berlin A. Top Ten Tips Palliative Care Clinicians Should Know About Leveraging the Electronic Health Record for Data Collection and Quality Improvement. J Palliat Med 2022. [PMID: 36525521 DOI: 10.1089/jpm.2022.0536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
As palliative care (PC) programs rapidly grow and expand across settings, the need to measure, improve, and standardize high-quality PC has also grown. The electronic health record (EHR) is a key component of these efforts as a central hub of care delivery and a repository of patient and system data. Deliberate efforts to leverage the EHR for PC quality improvement (QI) can help PC programs and health systems improve care for patients with serious illnesses. This article, written by clinicians with experience in QI, informatics, and clinical program development, provides practical tips and guidance on EHR strategies and tools for QI and quality measurement.
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Affiliation(s)
- Michael T. Huber
- Division of Geriatrics and Palliative Medicine, Department of Medicine, University of Miami, Miami, Florida, USA
| | - David Y. Ling
- Division of General Medicine, Geriatrics, and Palliative Care, Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Alan S. Rozen
- Platinum Palliative Care, LLC, Nashville, Tennessee, USA
| | - Stephanie Y. Terauchi
- Section of Palliative Medicine, Department of General Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA
| | | | - Jessica Fleischer-Black
- Department of Emergency Medicine and Brookdale, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Laura A. Schoenherr
- Division of Palliative Medicine, Department of Medicine, University of California, San Francisco (UCSF), San Francisco, California, USA
| | | | - Charlotta Lindvall
- Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, and Harvard Medical School, Boston, Massachusetts, USA
| | - Christopher A. Jones
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Roshni T. Guerry
- Division of General Internal Medicine/Palliative Care, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ana Berlin
- Division of General Surgery, Department of Surgery, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
- Division of Palliative Care, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
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14
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Padayachee J, Liu Z, Berlin A, Helou J, Winter J, Kong V, Glicksman R, Raman S, Weersink R, Chung P. HDR Focal Boost with Whole Gland SBRT in Localized Prostate Cancer: Assessment of Acute Toxicity and Early Quality of Life. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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15
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Gutierrez E, Ramotar M, Helou J, Raman S, Glicksman R, Rink A, Chung P, Weersink R, Berlin A. Focal MR-Guided High-Dose-Rate Brachytherapy for Localized Prostate Cancer: A Prospective Clinical Trial. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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16
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Baydoun A, Sun Y, Sandler H, Bolla M, Nabid A, Denham J, Jia A, Zaorsky N, Garcia J, Brown J, Jackson W, Dess R, Efstathiou J, Feng F, Maingon P, Steigler A, Souhami L, Berlin A, Kishan A, Spratt D. Efficacy of Bicalutamide Monotherapy in Prostate Cancer: A Network Meta-Analysis of 10 Randomized Trials. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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17
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Spohn S, Draulans C, Kishan A, Spratt D, Ross A, Maurer T, Tilki D, Berlin A, Blanchard P, Collins S, Bronsert P, Chen R, Dal Pra A, De Meerler G, Eade T, Haustermans K, Hölscher T, Höcht S, Ghadjar P, Davicioni E, Heck M, Kerkmeijer L, Kirste S, Tselis N, Tran P, Pinkawa M, Pommier P, Deltas C, Schmidt-Hegemann NS, Wiegel T, Zilli T, Tree A, Qiu X, Murthy V, Epstein J, Graztke C, Grosu A, Kamran S, Zamboglou C, Pinkawa. Genomic classifiers in personalized prostate cancer radiotherapy approaches – a systematic review and future perspectives based on international consensus. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)02485-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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18
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Berlin A. Close Encounters of the First Kind: An Interdisciplinary Ethics of Care Approach Mitigates Moral Injury and Family Division in the Midst of Covid-19. J Pain Symptom Manage 2022; 64:e159-e164. [PMID: 34022390 PMCID: PMC9361467 DOI: 10.1016/j.jpainsymman.2021.03.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 03/05/2021] [Accepted: 03/31/2021] [Indexed: 11/21/2022]
Abstract
In this compelling personal narrative describing a case from the front lines of the COVID-19 pandemic, a palliative care physician harnesses the creative powers and strengths of the interdisciplinary team to provide compassionate care to a critically ill patient and his family. The author describes the process of identifying a surrogate decision maker from among the patient's many adult children-several of whom were estranged from him and each other-and facilitating weighty decisions about his end-of-life care. Over the course of this journey, the author grapples with her inner biases and struggles with the emotional trauma associated with bearing witness to extraordinary suffering and social isolation imposed by COVID-19. Not only does the ethics of care approach embodied here lead to the creation of enduring vibrant works of art for this patient and others, but it also affirms a guiding principle of palliative care in which interdisciplinary collaboration is marshalled in the service of cultivating relationships, upholding responsibilities, and intensifying empathy among persons tied together by a common narrative.
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Affiliation(s)
- Ana Berlin
- Department of Surgery, Division of General Surgery, Department of Medicine, Division of Hematology/Oncology, Adult Palliative Medicine Service, Columbia University Irving Medical Center, New York, New York.
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Berlin A. SP-1019 Capitalising on research to transform clinical workflows and mindsets: our journey with patient-reported measures from siloed to system-wide. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)04116-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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20
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Kong V, Padayachee J, Winter J, Dang J, Li W, Navarro I, Glicksman R, Malkov V, Helou J, Berlin A, Chung P. OC-0784 Assessment of intraprostatic tumour motion in prostate radiotherapy on the MR-Linac. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02690-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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21
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Dang J, Li W, Navarro I, Winter J, Berlin A, Chung P, Glicksman R, Helou J, Malkov V, Padayachee J, Raman S, Kong V. OC-0783 Is full adaptation needed for prostate stereotactic body radiotherapy? A dosimetric comparison. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02689-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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22
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Nwigwe V, Berlin A, Cowan J, Coleman N, Lenihan L, Seres D, Fischkoff K. Reduction of Unnecessary Gastrostomy Tube Placement in Hospitalized Patients. Jt Comm J Qual Patient Saf 2022; 48:319-325. [DOI: 10.1016/j.jcjq.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 03/05/2022] [Accepted: 03/07/2022] [Indexed: 11/25/2022]
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23
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Zlotta A, Ballas L, Niemierko A, Lajkosz K, Kuk C, Miranda G, Drumm M, Mari A, Thio E, Fleshner N, Kulkarni G, Chung P, Bristow R, Berlin A, Sridhar S, Feldman A, Wszolek M, Lee R, Zietman A, Shipley W, Saylor P, Daneshmand S, Efstathiou J. Propensity matched comparison of radical cystectomy with trimodality therapy for muscle invasive bladder cancer (MIBC): A multi-institutional study. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00840-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Perlis N, Finelli A, Lovas M, Lund A, Di Meo A, Lajkosz K, Berlin A, Papadakos J, Ghai S, Deniffel D, Meng E, Wiljer D, Alibhai S, Bakas V, Badzynski A, Lee O, Cafazzo J, Haider M. Exploring the value of using patient-oriented mri reports in clinical practice. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00558-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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25
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Wettstein M, Berlin A, Pham S, Sridhar S, Chung P, Shabbir A, Van Der Kwast T, Qadri S, Li K, Liu N, Hermanns T, Kukarni G. Trimodal therapy versus radical cystectomy for T2 bladder cancer: real-world evidence from Ontario. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00846-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Berlin A, Johnston FM. Surgical palliative care: coming back to the future of care. Ann Palliat Med 2022; 11:850-851. [PMID: 35144388 DOI: 10.21037/apm-22-64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 01/24/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Ana Berlin
- Department of Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Fabian M Johnston
- Division of Surgical Oncology, Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA
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Padayachee J, Sanmamed N, Lee J, Liu Z, Berlin A, Craig T, Lao B, Rink A, Bayley A, Catton C, Sundaramurthy A, Foltz W, McPartlin A, Ghai S, Atenafu E, Gospodarowicz M, Warde P, Helou J, Raman S, Menard C, Chung P. Local Control in Tumor-Targeted Dose Escalation for Localized Prostate Cancer. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Ma T, Xiang M, Tilki D, Karnes R, Stish B, Martinez-Monge R, Tendulkar R, Klein E, Tran P, Tosoian J, Berlin A, Tward J, Merrick G, Spratt D, Krauss D, Horwitz E, Gafita A, Grogan T, Calais J, Kishan A. Prognostic Significance of the Risk of Non-localized Disease on PSMA/PET: Comparative Performance of a Novel, PSMA/PET-Derived Risk Stratification Tool for High-Risk Prostate Cancer in a Large, Multi-Institutional Cohort. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.135] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Kishan A, Wong J, Merrick G, Tran P, Demanes D, Stish B, Krauss D, Wedde T, Lilleby W, Stock R, Horwitz E, Steinberg M, Tendulkar R, Moran B, Tward J, Martinez-Monge R, Berlin A, Spratt D, Dess R, Romero T. The Relationship Between Androgen Deprivation Therapy Duration and External Beam Radiotherapy With or Without a Brachytherapy Boost in High-Risk Prostate Cancer. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Navarro I, Joseph L, Liu Z, Berlin A, Helou J, Raman S, Weersink R, Rink A, Lao B, Menard C, Chung P. Physician and Patient Reported Morbidity After MR-Guided Salvage Brachytherapy for Prostate Cancer. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Jaworski E, Fang F, Gharzai L, McFarlane M, Solanki A, Zaorsky N, Mahal B, Feng F, Ponsky L, Garcia J, Fredman E, Guo G, Berlin A, Roy S, Jackson W, Dess R, Schipper M, Spratt D. Utility of Long-Term Follow-Up to Determine Safety in Radiotherapy-Specific Trials for Localized Prostate Cancer: Meta-Analysis of 29 Randomized Trials. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Asprec L, Blinderman CD, Berlin A, Callahan ME, Widera E, Periyakoil VS, Smith AK, Nakagawa S. Virtual Interinstitutional Palliative Care Consultation during the COVID-19 Pandemic in New York City. J Palliat Med 2021; 24:1387-1390. [PMID: 34191591 DOI: 10.1089/jpm.2021.0208] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Context: Amid the COVID-19 surge in New York City, the need for palliative care was highlighted. Virtual consultation was introduced to expand specialist-level care to meet demand. Objectives: To examine the outcomes of COVID-19 patients who received virtual palliative care consultation from outside institutions. Design: This is a retrospective case series. Setting/Subjects: Subjects were 34 patients who received virtual palliative care consultation between April 13, 2020, and June 14, 2020. Measurements: Follow-up frequency and duration, code status change, withdrawal of life-sustaining treatment (LST), and multidisciplinary involvement. Results: Twenty-eight patients (82.3%) were in the intensive care unit and 29 patients (85.3%) were on at least two LSTs. Fifteen patients (44.1%) died in the hospital, 9 patients (26.4%) were discharged alive, and 10 patients (29.4%) were signed off. The median frequency of visits was 4.5 (IQR 6) over 11 days follow-up (IQR 17). Code status change was more frequent in deceased patients. LSTs were withdrawn in eight patients (23.5%). Conclusions: Virtual palliative care consultation was feasible during the height of the COVID-19 pandemic.
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Affiliation(s)
- Lawrence Asprec
- Adult Palliative Care Service, Department of Medicine, Department of Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Craig D Blinderman
- Adult Palliative Care Service, Department of Medicine, Department of Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Ana Berlin
- Adult Palliative Care Service, Department of Medicine, Department of Surgery, Columbia University Irving Medical Center, New York, New York, USA.,Division of General Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Mary E Callahan
- Adult Palliative Care Service, Department of Medicine, Department of Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Eric Widera
- Division of Geriatrics, Department of Medicine, University of California San Francisco, San Francisco, California, USA.,Geriatrics, Palliative, and Extended Care Service, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Vyjeyanthi S Periyakoil
- Department of Medicine, Stanford University, Palo Alto, California, USA.,Extended Care and Palliative Medicine Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
| | - Alexander K Smith
- Division of Geriatrics, Department of Medicine, University of California San Francisco, San Francisco, California, USA.,Geriatrics, Palliative, and Extended Care Service, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Shunichi Nakagawa
- Adult Palliative Care Service, Department of Medicine, Department of Surgery, Columbia University Irving Medical Center, New York, New York, USA
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Schwarze ML, Buffington A, Tucholka JL, Hanlon B, Rathouz PJ, Marka N, Taylor LJ, Zimmermann CJ, Kata A, Baggett ND, Fox DA, Schmick AE, Berlin A, Glass NE, Mosenthal AC, Finlayson E, Cooper Z, Brasel KJ. Effectiveness of a Question Prompt List Intervention for Older Patients Considering Major Surgery: A Multisite Randomized Clinical Trial. JAMA Surg 2021; 155:6-13. [PMID: 31664452 DOI: 10.1001/jamasurg.2019.3778] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Poor preoperative communication can have serious consequences, including unwanted treatment and postoperative conflict. Objective To compare the effectiveness of a question prompt list (QPL) intervention vs usual care on patient engagement and well-being among older patients considering major surgery. Design, Setting, and Participants This randomized clinical trial used a stepped-wedge design to randomly assign patients to a QPL intervention (n = 223) or usual care (n = 223) based on the timing of their visit with 1 of 40 surgeons at 5 US study sites. Patients were 60 years or older with at least 1 comorbidity and an oncologic or vascular (cardiac, neurosurgical, or peripheral vascular) problem that could be treated with major surgery. Family members were also enrolled (n = 263). The study dates were June 2016 to November 2018. Data analysis was by intent-to-treat. Interventions A brochure of 11 questions to ask a surgeon developed by patient and family stakeholders plus an endorsement letter from the surgeon were sent to patients before their outpatient visit. Main Outcomes and Measures Primary patient engagement outcomes included the number and type of questions asked during the surgical visit and patient-reported Perceived Efficacy in Patient-Physician Interactions scale assessed after the surgical visit. Primary well-being outcomes included (1) the difference between patient's Measure Yourself Concerns and Well-being (MYCaW) scores reported after surgery and scores reported after the surgical visit and (2) treatment-associated regret at 6 to 8 weeks after surgery. Results Of 1319 patients eligible for participation, 223 were randomized to the QPL intervention and 223 to usual care. Among 446 patients, the mean (SD) age was 71.8 (7.1) years, and 249 (55.8%) were male. On intent-to-treat analysis, there was no significant difference between the QPL intervention and usual care for all patient-reported primary outcomes. The difference in MYCaW scores for family members was greater in usual care (effect estimate, 1.51; 95% CI, 0.28-2.74; P = .008). When the QPL intervention group was restricted to patients with clear evidence they reviewed the QPL, a nonsignificant increase in the effect size was observed for questions about options (odds ratio, 1.88; 95% CI, 0.81-4.35; P = .16), expectations (odds ratio, 1.59; 95% CI, 0.67-3.80; P = .29), and risks (odds ratio, 2.41; 95% CI, 1.04-5.59; P = .04) (nominal α = .01). Conclusions and Relevance The results of this study were null related to primary patient engagement and well-being outcomes. Changing patient-physician communication may be difficult without addressing clinician communication directly. Trial Registration ClinicalTrials.gov identifier: NCT02623335.
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Affiliation(s)
| | - Anne Buffington
- Department of Surgery, University of Wisconsin-Madison, Madison
| | | | - Bret Hanlon
- Department of Biostatistics & Medical Informatics, University of Wisconsin-Madison, Madison
| | - Paul J Rathouz
- Department of Population Health, The University of Texas at Austin, Austin
| | - Nicholas Marka
- Department of Surgery, University of Wisconsin-Madison, Madison
| | - Lauren J Taylor
- Department of Surgery, University of Wisconsin-Madison, Madison
| | | | - Anna Kata
- Division of Geriatrics, Department of Medicine, University of California, San Francisco
| | | | - Daniel A Fox
- School of Medicine, Northwestern University, Evanston, Illinois
| | - Andrea E Schmick
- Department of Medicine, University of Wisconsin-Madison, Madison
| | - Ana Berlin
- Division of General Surgery, Department of Surgery, Columbia University Medical Center, New York, New York.,Adult Palliative Medicine Service, Division of Hematology/Oncology, Department of Medicine, Columbia University Medical Center, New York, New York
| | - Nina E Glass
- Department of Surgery, Rutgers New Jersey Medical School, Newark
| | - Anne C Mosenthal
- Department of Surgery, Rutgers New Jersey Medical School, Newark
| | - Emily Finlayson
- Department of Surgery, University of California, San Francisco
| | - Zara Cooper
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Karen J Brasel
- Department of Surgery, Oregon Health and Science University, Portland
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Blitzer D, Berlin A, Guariento A, Mayer JE. Redefining Palliative Surgery: the Congenital Cardiac Surgery Experience. Ann Thorac Surg 2021; 113:383-385. [PMID: 34126074 DOI: 10.1016/j.athoracsur.2021.05.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 05/14/2021] [Accepted: 05/15/2021] [Indexed: 12/01/2022]
Affiliation(s)
- David Blitzer
- Department of Surgery, Columbia University, New York, NY USA.
| | - Ana Berlin
- Department of Surgery, Columbia University, New York, NY USA
| | - Alvise Guariento
- Division of Cardiovascular Surgery, Department of Surgery, Hospital for Sick Children, Toronto, Canada
| | - John E Mayer
- Department of Cardiovascular Surgery, Boston Children's Hospital, MA
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Locke G, Crook J, Catton C, Liu Z, Raman S, Chung P, Berlin A, Fleshner N, Helou J. Long Term Biochemical Control of a Prospective Cohort of Prostate Cancer Patients Treated with Interstitial Brachytherapy Versus Radical Prostatectomy. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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36
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Huo M, Shultz D, Laperriere N, Hodaie M, Cusimano M, Gentili F, Payne D, Berlin A, Schwartz M, Millar B, Zadeh G, Coolens C, Tsang D. PO-0855: Radiation-induced meningiomas: outcomes following stereotactic radiosurgery. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00872-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Huo M, Morley L, Dawson L, Bissonnette J, Helou J, Giuliani M, Berlin A, Shultz D, Hosni A, Shessel A, Barry A. PO-1757: Peer Review in Stereotactic Body Radiotherapy: The Impact of Case Volume. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01775-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Tjong M, Lunsky I, Ajib K, Sridhar S, Fleshner N, Zlotta A, Berlin A, Kulkarni G, Chung P. PO-1213: Pelvic radiotherapy in node positive bladder cancer – outcomes in a selected cohort. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01231-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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BettolI P, Liu Z, Jara N, Fong C, Wong W, Terlizzi M, Sargos P, Zillie T, Thariat J, Ploussard G, Goyal S, Chung P, Berlin A, Sole C. PO-1219: Primary Bladder Sarcoma: a multiinstitutional experience from the Rare Cancer Network. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01237-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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40
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Fong C, Padayachee J, Liu Z, Weiss J, Lao B, Gumapac N, Bettoli P, Sanmamed N, Rink A, Weersink R, Bayley A, Raman S, Helou J, Catton C, Warde P, Berlin A, Menard C, Chung P. Preliminary Results Of MR-Guided Brachytherapy Boost To External Beam Radiotherapy For Intermediate And High Risk Prostate Cancer. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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41
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Goldberg H, Mohsin F, Saskin R, Kulkarni G, Berlin A, Kenk M, Wallis C, Chandeasekar T, Klaassen Z, Saarela O, Penn L, Shabbir A, Fleshner N. The deleterious association between proton pump inhibitors and prostate cancer-specific death – a population-based cohort study. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)32733-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Nakagawa S, Berlin A, Widera E, Periyakoil VS, Smith AK, Blinderman CD. Pandemic Palliative Care Consultations Spanning State and Institutional Borders. J Am Geriatr Soc 2020; 68:1683-1685. [PMID: 32441788 PMCID: PMC7280694 DOI: 10.1111/jgs.16643] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 05/18/2020] [Indexed: 01/02/2023]
Affiliation(s)
- Shunichi Nakagawa
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Ana Berlin
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Eric Widera
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | | | - Alexander K Smith
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Craig D Blinderman
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
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Chernock B, Hwang F, Berlin A, Pentakota SR, Singh R, Singh R, Mosenthal AC. Emergency abdominal surgery in patients presenting from skilled nursing facilities: Opportunities for palliative care. Am J Surg 2020; 219:1076-1082. [DOI: 10.1016/j.amjsurg.2019.09.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 09/06/2019] [Accepted: 09/17/2019] [Indexed: 01/16/2023]
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Hwang F, McGreevy CM, Pentakota SR, Verde D, Park JH, Berlin A, Glass NE, Livingston DH, Mosenthal A. Sarcopenia is Predictive of Functional Outcomes in Older Trauma Patients. Cureus 2019; 11:e6154. [PMID: 31890363 PMCID: PMC6913963 DOI: 10.7759/cureus.6154] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Introduction: Older patients are more vulnerable to poor outcomes after trauma than younger patients. Sarcopenia, loss of skeletal mass, is prevalent in trauma patients admitted to the intensive care unit (ICU), and it has been shown to correlate with adverse outcomes, such as mortality and ICU days. Yet, little is known whether it predicts other outcomes. We hypothesized that sarcopenia independently predicts poor functional outcomes in older trauma patients admitted to the ICU. Methods: We performed a retrospective review of patients aged >55 admitted to a surgical ICU in a Level I trauma center for two years. Sarcopenic status was determined by measuring total skeletal muscle cross-sectional area at the L3 level on admission computed tomography (CT), normalized for height with sex-specific cutoffs. Primary outcome measures were in-hospital mortality, functional outcomes measured by the Glasgow Outcome Scale (GOS) at discharge, and discharge disposition. Multivariable logistic regression was used to determine predictors of primary outcomes. Results: Out of 230 patients, 32% were sarcopenic. The overall mortality was 20%, and 30% were discharged with poor functional outcomes. A higher proportion of sarcopenic patients among survivors had poor functional outcomes at discharge (55% vs. 30%, p=0.002). Sarcopenia was not predictive of in-hospital mortality but was an independent predictor of poor functional outcomes at discharge (OR 2.6; 95% confidence interval [CI] 1.3-5.5), adjusting for age, Glasgow Coma Scale (GCS) on admission, diagnosis of traumatic brain injury (TBI), Injury Severity Score (ISS), and the number of life-limiting illnesses. Conclusions: Sarcopenia is prevalent in geriatric trauma ICU patients and is an independent predictor of poor functional outcomes. Assessing for sarcopenia has an important potential as a prognostic tool in older trauma patients.
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Affiliation(s)
| | | | | | - Davis Verde
- Anesthesiology, Columbia University, New York, USA
| | - Joo Hye Park
- Internal Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, USA
| | - Ana Berlin
- Surgery, Columbia University, New York, USA
| | - Nina E Glass
- Surgery, Rutgers New Jersey Medical School, Newark, USA
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Grover K, Onishi A, Scully B, Hsieh C, Fingeret A, Hochman B, Berlin A, Nowygrod R. Maturation of a Surgical Education Fellowship over a Decade. J Am Coll Surg 2019. [DOI: 10.1016/j.jamcollsurg.2019.08.539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Nakagawa S, Fischkoff K, Berlin A, Arnell TD, Blinderman CD. Communication Skills Training for General Surgery Residents. J Surg Educ 2019; 76:1223-1230. [PMID: 31005480 DOI: 10.1016/j.jsurg.2019.04.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 02/19/2019] [Accepted: 04/02/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Although good communication skills are essential for surgeons, there is no formal communication training during general surgery residency. OBJECTIVES To implement a communication skills training program based on evidence-based teaching methods in general surgery residency. DESIGN We developed a 2-hour communication skills training program for general surgery residents, consisting of a small group skill practice session using role play with simulated patients along with real-time feedback from facilitators and observing peer residents. A board-certified palliative care physician and a board-certified surgeon facilitated each session. Outcome measures were self-assessment of preparedness with the session immediately before and after the session and 2 months after the session, resident satisfaction, and self-report frequency of skill practice. Results were compared between junior residents (postgraduate year 1-3) and senior residents (postgraduate year 4-5). SETTING Columbia University Medical Center in New York City, a tertiary care, urban academic center with a 5-year General Surgery Residency program. PARTICIPANTS Thirty-one out of 39 (79.4%) general surgery residents (20 junior and 11 senior) were trained over a 9-month period. All participants completed the immediate pre- and post-session surveys, and twenty residents (64.5%) completed the 2-month postsession follow-up survey. RESULTS Overall, self-assessment of preparedness for specific communication challenges improved significantly for 7 of 11 tasks. At baseline, senior residents felt significantly more prepared than junior residents in all 11 tasks. Junior residents' self-assessment of preparedness improved significantly in 10 of 11 tasks. Overall satisfaction with the session was very high (mean 4.74 on a 5-point scale). Residents reported high frequency of self-directed skill practice in the 2-month follow-up survey. CONCLUSIONS This 2-hour communication skills practice session for general surgery residents was feasible, and it improved resident self-assessment of preparedness in communication and augmented self-directed skill practice.
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Affiliation(s)
- Shunichi Nakagawa
- Department of Medicine, Adult Palliative Care Services, Columbia University Medical Center, New York, New York.
| | - Katherine Fischkoff
- Department of Surgery, Division of General Surgery, Columbia University Medical Center, New York, New York
| | - Ana Berlin
- Department of Medicine, Adult Palliative Care Services, Columbia University Medical Center, New York, New York; Department of Surgery, Division of General Surgery, Columbia University Medical Center, New York, New York
| | - Tracey D Arnell
- Department of Surgery, Division of General Surgery, Columbia University Medical Center, New York, New York
| | - Craig D Blinderman
- Department of Medicine, Adult Palliative Care Services, Columbia University Medical Center, New York, New York
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Dess R, Suresh K, Zelefsky M, Cooperberg M, Mahal B, Davis B, Horwitz E, DeWeese T, Song D, Berlin A, Moraes F, Briganti A, Gandaglia G, Freedland S, Feng F, Carroll P, Karnes R, Kattan M, Schipper M, Spratt D. Development and Validation of the First AJCC Compliant Clinical Staging System for Localized Prostate Cancer: Results from a Multicenter International Study. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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48
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Glicksman R, Metser U, Vines D, Chan R, Valliant J, Chung P, Gospodarowicz M, Bayley A, Catton C, Warde P, Helou J, Lalani N, Green D, Perlis N, Fleshner N, Hamilton R, Zlotta A, Finelli A, Jaffray D, Berlin A. Preliminary Results of a Two Stage Phase II Study of 18F-DCFPyL PET-MR for Enabling Oligometastases Ablative Therapy in Subclinical Prostate Cancer. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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49
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Sanmamed N, Glicksman R, Heaton J, Herrera-Caceres J, Joseph L, Hansen A, Chung P, Finelli A, Fleshner N, Berlin A. Use of Combined Hormone Therapy with Post-Operative Radiation Treatment for Prostate Cancer: Impact of Randomized Trials On Clinical Practice. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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50
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Tjong M, Lunsky I, Ajib K, Erlich A, Maganti M, Sridhar S, Fleshner N, Zlotta A, Berlin A, Kulkarni G, Chung P. Selective Use of Radiation-Based Management in Localized Muscle-Invasive Bladder Cancer. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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