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Kopelman ZA, Tian C, Tumas J, Phippen NT, Tarney CM, Hope ER, Winkler SS, Jokajtys S, Kucera CW, Chan JK, Richardson MT, Kapp DS, Hamilton CA, Leath CA, Jones NL, Rocconi RP, Farley JH, Secord AA, Cosgrove CM, Powell MA, Klopp A, Walker JL, Fleming GF, Bateman NW, Conrads TP, Maxwell GL, Darcy KM. Disease progression, survival, and molecular disparities in Black and White patients with endometrioid endometrial carcinoma in real-world registries and GOG/NRG oncology randomized phase III clinical trials. Gynecol Oncol 2024; 183:103-114. [PMID: 38593674 DOI: 10.1016/j.ygyno.2024.03.026] [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: 01/17/2024] [Revised: 03/25/2024] [Accepted: 03/27/2024] [Indexed: 04/11/2024]
Abstract
OBJECTIVE Investigate racial disparities in outcomes and molecular features in Black and White patients with endometrioid endometrial carcinoma (EEC). METHODS Black and White patients diagnosed with EEC who underwent hysterectomy ± adjuvant treatment in SEER, National Cancer Database (NCDB), the Genomics Evidence Neoplasia Information Exchange (GENIE) project (v.13.0), and eight NCI-sponsored randomized phase III clinical trials (RCTs) were studied. Hazard ratio (HR) and 95% confidence interval (CI) were estimated for cancer-related death (CRD), non-cancer death (NCD), and all-cause death. RESULTS Black (n = 4397) vs. White (n = 47,959) patients in SEER had a HR (95% CI) of 2.04 (1.87-2.23) for CRD and 1.22 (1.09-1.36) for NCD. In NCDB, the HR (95% CI) for death in Black (n = 13,468) vs. White (n = 155,706) patients was 1.52 (1.46-1.58) dropping to 1.29 (1.23-1.36) after propensity-score matching for age, comorbidity, income, insurance, grade, stage, LVSI, and treatment. In GENIE, Black (n = 109) vs. White (n = 1780) patients had fewer PTEN, PIK3R1, FBXW7, NF1, mTOR, CCND1, and PI3K-pathway-related gene mutations. In contrast, TP53 and DNA-repair-related gene mutation frequency as well as tumor mutational burden-high status were similar in Black and White patients. In RCTs, Black (n = 187) vs. White (n = 2877) patients were more likely to have advanced or recurrent disease, higher grade, worse performance status and progressive disease. Risk of death in Black vs. White patients in RCTs was 2.19 (1.77-2.71) persisting to 1.32 (1.09-1.61) after matching for grade, stage, and treatment arm while balancing age and performance status. CONCLUSIONS Differences exist in clinical presentation, outcomes, and molecular features in Black vs. White patients with EEC in real-world registries and RCTs. Targeted-drug development, strategies to modify social determinants, and diverse inclusion in RCTs are approaches to reduce disparities.
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Affiliation(s)
- Zachary A Kopelman
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Chunqiao Tian
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; The Henry M Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA
| | - Jordyn Tumas
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Neil T Phippen
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Christopher M Tarney
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Erica R Hope
- Division of Gynecologic Oncology, Department of Gynecologic Surgery and Obstetrics, Brooke Army Medical Center, San Antonio, TX, USA
| | - Stuart S Winkler
- Division of Gynecologic Oncology, Department of Gynecologic Surgery and Obstetrics, Brooke Army Medical Center, San Antonio, TX, USA
| | - Suzanne Jokajtys
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Calen W Kucera
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - John K Chan
- Palo Alto Medical Foundation, California Pacific Medical Center, Sutter Health, San Francisco, CA, USA
| | - Michael T Richardson
- Department of Obstetrics and Gynecology, University of California, Los Angeles School of Medicine, Los Angeles, CA, USA
| | - Daniel S Kapp
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA
| | - Chad A Hamilton
- Gynecologic Oncology Section, Women's Services and The Ochsner Cancer Institute, Ochsner Health, New Orleans, LA, USA
| | - Charles A Leath
- Division of Gynecologic Oncology, University of Alabama at Birmingham, O'Neal Comprehensive Cancer Center, Birmingham, AL, USA
| | - Nathaniel L Jones
- Division of Gynecologic Oncology, Mitchell Cancer Institute, University of South Alabama, Mobile, AL, USA
| | - Rodney P Rocconi
- Division of Gynecologic Oncology, Cancer Center & Research Institute, the University of Mississippi Medical Center, Jackson, MS, USA
| | - John H Farley
- Division of Gynecologic Oncology, Center for Women's Health, Cancer Institute, Dignity Health St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | | | - Casey M Cosgrove
- Division of Gynecologic Oncology, The Ohio State University, Columbus, OH, USA
| | - Matthew A Powell
- Division of Gynecologic Oncology, Siteman Cancer Center, Washington University, St Louis, MO, USA
| | - Ann Klopp
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Joan L Walker
- Gynecologic Oncology Division, Stephenson Cancer Center, Oklahoma University Health Sciences Center, Oklahoma City, OK, USA
| | - Gini F Fleming
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Nicholas W Bateman
- Division of Gynecologic Oncology, Center for Women's Health, Cancer Institute, Dignity Health St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA; The Henry M Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA
| | - Thomas P Conrads
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; The Henry M Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA; Women's Health Integrated Research Center, Inova Women's Service Line, Inova Health System, Falls Church, VA, USA
| | - G Larry Maxwell
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; The Henry M Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA; Women's Health Integrated Research Center, Inova Women's Service Line, Inova Health System, Falls Church, VA, USA.
| | - Kathleen M Darcy
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; The Henry M Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA.
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2
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Sitler CA, Tian C, Hamilton CA, Richardson MT, Chan JK, Kapp DS, Leath CA, Casablanca Y, Washington C, Chappell NP, Klopp AH, Shriver CD, Tarney CM, Bateman NW, Conrads TP, Maxwell GL, Phippen NT, Darcy KM. Immuno-Molecular Targeted Therapy Use and Survival Benefit in Patients with Stage IVB Cervical Carcinoma in Commission on Cancer ®-Accredited Facilities in the United States. Cancers (Basel) 2024; 16:1071. [PMID: 38473428 DOI: 10.3390/cancers16051071] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 02/27/2024] [Accepted: 03/03/2024] [Indexed: 03/14/2024] Open
Abstract
PURPOSE To investigate IMT use and survival in real-world stage IVB cervical cancer patients outside randomized clinical trials. METHODS Patients diagnosed with stage IVB cervical cancer during 2013-2019 in the National Cancer Database and treated with chemotherapy (CT) ± external beam radiation (EBRT) ± intracavitary brachytherapy (ICBT) ± IMT were studied. The adjusted hazard ratio (AHR) and 95% confidence interval (CI) for risk of death were estimated in patients treated with vs. without IMT after applying propensity score analysis to balance the clinical covariates. RESULTS There were 3164 evaluable patients, including 969 (31%) who were treated with IMT. The use of IMT increased from 11% in 2013 to 46% in 2019. Age, insurance, facility type, sites of distant metastasis, and type of first-line treatment were independently associated with using IMT. In propensity-score-balanced patients, the median survival was 18.6 vs. 13.1 months for with vs. without IMT (p < 0.001). The AHR was 0.72 (95% CI = 0.64-0.80) for adding IMT overall, 0.72 for IMT + CT, 0.66 for IMT + CT + EBRT, and 0.69 for IMT + CT + EBRT + ICBT. IMT-associated survival improvements were suggested in all subgroups by age, race/ethnicity, comorbidity score, facility type, tumor grade, tumor size, and site of metastasis. CONCLUSIONS IMT was associated with a consistent survival benefit in real-world patients with stage IVB cervical cancer.
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Affiliation(s)
- Collin A Sitler
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | - Chunqiao Tian
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, MD 20817, USA
| | - Chad A Hamilton
- Gynecologic Oncology Section, Women's Services and The Ochsner Cancer Institute, Ochsner Health, New Orleans, LA 70115, USA
| | - Michael T Richardson
- Department of Obstetrics and Gynecology, Los Angeles School of Medicine, University of California, Los Angeles, CA 90024, USA
| | - John K Chan
- Palo Alto Medical Foundation, California Pacific Medical Center, Sutter Health, San Francisco, CA 94010, USA
| | - Daniel S Kapp
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Charles A Leath
- Division of Gynecologic Oncology, University of Alabama at Birmingham, O'Neal Comprehensive Cancer Center, Birmingham, AL 35249, USA
| | - Yovanni Casablanca
- Gynecologic Oncology Division, Levine Cancer Institute, Atrium Health, Charlotte, NC 28204, USA
| | - Christina Washington
- Gynecologic Oncology Division, Stephenson Cancer Center, Oklahoma University Health Sciences Center, Oklahoma City, OK 73104, USA
| | - Nicole P Chappell
- Gynecologic Oncology Division, GW Medical Faculty Associates, George Washington University, Washington, DC 20037, USA
| | - Ann H Klopp
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Craig D Shriver
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | - Christopher M Tarney
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | - Nicholas W Bateman
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, MD 20817, USA
| | - Thomas P Conrads
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
- Women's Health Integrated Research Center, Women's Service Line, Inova Health System, Falls Church, VA 22042, USA
| | - George Larry Maxwell
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
- Women's Health Integrated Research Center, Women's Service Line, Inova Health System, Falls Church, VA 22042, USA
| | - Neil T Phippen
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | - Kathleen M Darcy
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, MD 20817, USA
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3
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Johnson CR, Liao CI, Tian C, Richardson MT, Duong K, Tran N, Winkler SS, Kapp DS, Darcy K, Chan JK. Uterine cancer among Asian Americans - Disparities & clinical characteristics. Gynecol Oncol 2024; 182:24-31. [PMID: 38246043 DOI: 10.1016/j.ygyno.2023.12.023] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 12/19/2023] [Accepted: 12/22/2023] [Indexed: 01/23/2024]
Abstract
OBJECTIVE To evaluate the patterns and trends of uterine cancer among Asian subgroups living in the U.S. METHODS Data were obtained from United States Cancer Statistics (2001-2017), National Cancer Database (2004-2015), and World Population Review (2023). SEER*Stat version 8.3.9.2, Joinpoint regression program 4.9.0.0, and SAS v 9.4 were employed for statistical analysis. RESULTS Based on data from 778,891 women in the United States Cancer Statistics database, Asians had a 3.4-fold higher rate of incident uterine cancer compared to White populations (2.14% vs. 0.63%; p < 0.001). Using the National Cancer Database, 7,641 Asian women from six subgroups were analyzed: Filipino, Korean, Indian/Pakistani, Vietnamese, Chinese, and Japanese. Indian and Pakistani women had the greatest increase in the proportion of cancer diagnoses (5.0% to 14.4%; p = 0.0003). Additionally, Indian and Pakistani patients had higher comorbidity scores while Koreans had the lowest (22.7% vs. 10.7%, p < 0.0001). Regarding stage of disease, 25.3% of Filipinos presented with advanced stage disease compared to 19.2% of Indians and Pakistanis (p = 0.0001). Furthermore, Filipinos had the highest proportion of non-endometrioid cancers at 18.4% compared to other subgroups (p = 0.0003). Using the World Population Review, female obesity was highest in Pakistan (8.6%) and the Philippines (7.5%) and lowest in Vietnam (2.6%). CONCLUSION Uterine cancer incidence increased at higher rates among Asians compared to White populations. Specifically, Indian and Pakistani uterine cancer patients were more likely to have higher comorbidity rates and Filipino patients had more advanced stage cancer with non-endometrioid histologies than other Asian subgroups. Further research is warranted to better understand these trends.
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Affiliation(s)
- Caitlin R Johnson
- California Pacific Medical Center Research Institute, 1100 Van Ness, San Francisco, CA 94109, USA.
| | - Cheng-I Liao
- Pingtung Veterans General Hospital, Department of Obstetrics and Gynecology, Pingtung, Taiwan
| | - Chunqiao Tian
- Gynecologic Cancer Center of Excellence Program, Henry M Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA
| | - Michael T Richardson
- University of California, Los Angeles, Department of Obstetrics and Gynecology, 757 Westwood Blvd, Los Angeles, CA, USA
| | - Kim Duong
- Western University of Health Sciences, College of Osteopathic Medicine, 309 E 2nd St, Pomona, CA 91766, USA
| | - Nathan Tran
- California Pacific Medical Center Research Institute, 1100 Van Ness, San Francisco, CA 94109, USA
| | - Stuart S Winkler
- Brooke Army Medical Center, Department of Obstetrics and Gynecology, 3551 Roger Brooke Dr., Fort Sam Houston, TX, United States of America
| | - Daniel S Kapp
- Stanford University School of Medicine, Department of Radiation Oncology, 875 Blake Wilbur Dr, Stanford, CA 94304, USA
| | - Kathleen Darcy
- Gynecologic Cancer Center of Excellence Program, Henry M Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA
| | - John K Chan
- California Pacific Medical Center Research Institute, 1100 Van Ness, San Francisco, CA 94109, USA
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4
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Kucera CW, Chappell NP, Tian C, Richardson MT, Tarney CM, Hamilton CA, Chan JK, Kapp DS, Leath CA, Casablanca Y, Rojas C, Sitler CA, Wenzel L, Klopp A, Jones NL, Rocconi RP, Farley JH, O'Connor TD, Shriver CD, Bateman NW, Conrads TP, Phippen NT, Maxwell GL, Darcy KM. Survival disparities in non-Hispanic Black and White cervical cancer patients vary by histology and are largely explained by modifiable factors. Gynecol Oncol 2024; 184:224-235. [PMID: 38340648 DOI: 10.1016/j.ygyno.2024.02.005] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 01/30/2024] [Accepted: 02/04/2024] [Indexed: 02/12/2024]
Abstract
PURPOSE We investigated racial disparities in survival by histology in cervical cancer and examined the factors contributing to these disparities. METHODS Non-Hispanic Black and non-Hispanic White (hereafter known as Black and White) patients with stage I-IV cervical carcinoma diagnosed between 2004 and 2017 in the National Cancer Database were studied. Survival differences were compared using Cox modeling to estimate hazard ratio (HR) or adjusted HR (AHR) and 95% confidence interval (CI). The contribution of demographic, socioeconomic and clinical factors to the Black vs White differences in survival was estimated after applying propensity score weighting in patients with squamous cell carcinoma (SCC) or adenocarcinoma (AC). RESULTS This study included 10,111 Black and 43,252 White patients with cervical cancer. Black patients had worse survival than White cervical cancer patients (HR = 1.40, 95% CI = 1.35-1.45). Survival disparities between Black and White patients varied significantly by histology (HR = 1.20, 95% CI = 1.15-1.24 for SCC; HR = 2.32, 95% CI = 2.12-2.54 for AC, interaction p < 0.0001). After balancing the selected demographic, socioeconomic and clinical factors, survival in Black vs. White patients was no longer different in those with SCC (AHR = 1.01, 95% CI 0.97-1.06) or AC (AHR = 1.09, 95% CI = 0.96-1.24). In SCC, the largest contributors to survival disparities were neighborhood income and insurance. In AC, age was the most significant contributor followed by neighborhood income, insurance, and stage. Diagnosis of AC (but not SCC) at ≥65 years old was more common in Black vs. White patients (26% vs. 13%, respectively). CONCLUSIONS Histology matters in survival disparities and diagnosis at ≥65 years old between Black and White cervical cancer patients. These disparities were largely explained by modifiable factors.
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Affiliation(s)
- Calen W Kucera
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Nicole P Chappell
- George Washington Medical Faculty Associates, George Washington Cancer Center, Washington, DC, USA
| | - Chunqiao Tian
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; The Henry M Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Michael T Richardson
- Department of Obstetrics and Gynecology, University of California, Los Angeles School of Medicine, Los Angeles, CA. USA
| | - Christopher M Tarney
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Chad A Hamilton
- Gynecologic Oncology Section, Women's Services and The Ochsner Cancer Institute, Ochsner Health, New Orleans, LA, USA
| | - John K Chan
- Palo Alto Medical Foundation / California Pacific Medical Center /Sutter Health, San Francisco, CA, USA
| | - Daniel S Kapp
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA
| | - Charles A Leath
- Division of Gynecologic Oncology, University of Alabama at Birmingham, O'Neal Comprehensive Cancer Center, Birmingham, AL, USA
| | - Yovanni Casablanca
- Division of Gynecologic Oncology, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
| | - Christine Rojas
- Division of Gynecologic Oncology, Naval Medical Center Portsmouth, Portsmouth, VA, USA
| | - Collin A Sitler
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Lari Wenzel
- School of Medicine, University of California Irvine, Irvine, CA, USA
| | - Ann Klopp
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Nathaniel L Jones
- Division of Gynecologic Oncology, Mitchell Cancer Institute, University of South Alabama, Mobile, AL, USA
| | - Rodney P Rocconi
- Division of Gynecologic Oncology, Cancer Center & Research Institute, the University of Mississippi Medical Center, Jackson, MS, USA
| | - John H Farley
- Division of Gynecologic Oncology, Center for Women's Health, Cancer Institute, Dignity Health St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Timothy D O'Connor
- Institute for Genome Sciences, Department of Medicine and Program in Personalized and Genomic Medicine, and Program in Health Equity and Population Health, University of Maryland School of Medicine, Baltimore, MD, USA; University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, MD, USA
| | - Craig D Shriver
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Nicholas W Bateman
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; The Henry M Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Thomas P Conrads
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; Women's Health Integrated Research Center, Inova Women's Service Line, Inova Health System, Falls Church, VA, USA
| | - Neil T Phippen
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - G Larry Maxwell
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; Women's Health Integrated Research Center, Inova Women's Service Line, Inova Health System, Falls Church, VA, USA
| | - Kathleen M Darcy
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; The Henry M Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA.
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5
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Richardson MT, Barry D, Steinberg JR, Thirunavu V, Strom DE, Holder K, Zhang N, Turner BE, Magnani CJ, Weeks BT, Young AMP, Lu CF, Wolgemuth TR, Laasiri N, Squires NA, Anderson JN, Karlan BY, Chan JK, Kapp DS, Roque DR, Salani R. Underrepresentation of racial and ethnic minority groups in gynecologic oncology: An analysis of over 250 trials. Gynecol Oncol 2024; 181:1-7. [PMID: 38096673 DOI: 10.1016/j.ygyno.2023.12.001] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 11/29/2023] [Accepted: 12/02/2023] [Indexed: 03/01/2024]
Abstract
OBJECTIVE To describe the participation of racial and ethnic minority groups (REMGs) in gynecologic oncology trials. METHODS Gynecologic oncology studies registered on ClinicalTrials.gov between 2007 and 2020 were identified. Trials with published results were analyzed based on reporting of race/ethnicity in relation to disease site and trial characteristics. Expected enrollment by race/ethnicity was calculated and compared to actual enrollment, adjusted for 2010 US Census population data. RESULTS 2146 gynecologic oncology trials were identified. Of published trials (n = 252), 99 (39.3%) reported race/ethnicity data. Recent trials were more likely to report these data (36% from 2007 to 2009; 51% 2013-2015; and 53% from 2016 to 2018, p = 0.01). Of all trials, ovarian cancer trials were least likely to report race/ethnicity data (32.1% vs 39.3%, p = 0.011). Population-adjusted under-enrollment for Blacks was 7-fold in ovarian cancer, Latinx 10-fold for ovarian and 6-fold in uterine cancer trials, Asians 2.5-fold in uterine cancer trials, and American Indian and Alaska Native individuals 6-fold in ovarian trials. Trials for most disease sites have enrolled more REMGs in recent years - REMGs made up 19.6% of trial participants in 2007-2009 compared to 38.1% in 2016-2018 (p < 0.0001). CONCLUSION Less than half of trials that published results reported race/ethnicity data. Available data reveals that enrollment of REMGs is significantly below expected rates based on national census data. These disparities persisted even after additionally adjusting for population size. Despite improvement in recent years, additional recruitment of REMGs is needed to achieve more representative and equitable participation in gynecologic cancer clinical trials.
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Affiliation(s)
- Michael T Richardson
- Department of Obstetrics and Gynecology, University of California Los Angeles, Los Angeles, CA, United States of America
| | - Danika Barry
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Jecca R Steinberg
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Vineeth Thirunavu
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Danielle E Strom
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Kai Holder
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Naixin Zhang
- Division of Gynecologic Oncology, University of Rochester Medical Center, Rochester, NY, United States of America
| | - Brandon E Turner
- Harvard Radiation Oncology Program, Boston, MA, United States of America
| | - Christopher J Magnani
- Division of Urological Surgery, Brigham & Women's Hospital and Harvard Medical School, Boston, MA, United States of America
| | - Brannon T Weeks
- Brigham and Women's Hospital/Massachusetts General Hospital Integrated Residency Program in Obstetrics and Gynecology, Boston, MA, United States of America
| | - Anna Marie P Young
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Connie F Lu
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Tierney R Wolgemuth
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Nora Laasiri
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Natalie A Squires
- Department of Obstetrics and Gynecology, New York-Presbyterian/Weill Cornell Medical Center, New York, NY, United States of America
| | - Jill N Anderson
- Department of Obstetrics and Gynecology, New York-Presbyterian/Weill Cornell Medical Center, New York, NY, United States of America
| | - Beth Y Karlan
- Department of Obstetrics and Gynecology, University of California Los Angeles, Los Angeles, CA, United States of America
| | - John K Chan
- California Pacific / Palo Alto Medical Foundation / Sutter Research Institute, San Francisco, CA, United States of America
| | - Daniel S Kapp
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, United States of America
| | - Dario R Roque
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Ritu Salani
- Department of Obstetrics and Gynecology, University of California Los Angeles, Los Angeles, CA, United States of America.
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6
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Chan JK, Tian C, Kesterson JP, Lin KY, Darcy K, Richardson MT, Kapp DS, Monk BJ, McNally L, Landrum L, Copeland L, Walker JL, Wenham RM, Phippen N, Spirtos NM, Tewari K, Shahin M, Berry L, Bell JG. Preoperative and pre-chemotherapy CA-125 levels in high-risk early-stage ovarian cancer - An NRG/GOG study. Gynecol Oncol 2024; 181:54-59. [PMID: 38134754 DOI: 10.1016/j.ygyno.2023.12.009] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 12/04/2023] [Accepted: 12/11/2023] [Indexed: 12/24/2023]
Abstract
OBJECTIVES To determine clinical significance of preoperative and pre-chemotherapy CA-125 in high-risk early-stage epithelial ovarian cancer patients. METHODS All patients with stage IA/IB and grade 3, stage IC, clear cell, or completed resected stage II cancer were enrolled in a phase III trial and treated with chemotherapy. Kaplan-Meier method and Cox proportional hazards model were used for statistical analyses. RESULTS 427 patients with high-risk early-stage ovarian cancer were enrolled. Of 213 patients with preoperative CA-125 data, 79% had elevated CA-125. Median preoperative CA-125 level was 103 U/mL. Patients with ≤10, 11-15, and > 15 cm tumors had median preoperative CA-125 levels of 62, 131 and 158 U/mL, respectively (p = 0.002). For the 350 patients with data for pre-chemotherapy CA-125 level, 69% had elevated pre-chemotherapy CA-125 above 35 U/mL with median value of 65 U/mL. However, age, race, stage, cell type and grade of disease were not correlated with CA-125 levels before and after surgery. On multivariate analysis, elevated pre-chemotherapy CA-125 independently predicted worse recurrence-free survival (HR = 2.13, 95% CI: 1.23-3.69; p = 0.007) and overall survival (HR = 1.99, 95% CI: 1.10-3.59; p = 0.022) after adjusting for age, stage, cell type and grade of disease. Compared to those with normal CA-125, patients with elevated pre-chemotherapy CA-125 had lower recurrence-free survival (RFS, 87% vs. 75%; p = 0.007) and overall survival (OS, 88% vs. 82%; p = 0.02). However, preoperative CA-125 was not prognostic of RFS (p = 0.699) or OS (p = 0.701). CONCLUSIONS Preoperative CA-125 was elevated in nearly 80% of high-risk early-stage ovarian cancer patients. Pre-chemotherapy CA-125 was associated with recurrence-free and overall survival; however, preoperative CA-125 was not prognostic.
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Affiliation(s)
- John K Chan
- California Pacific/Palo Alto Medical Foundation/Sutter Research Institute, San Francisco, CA, USA.
| | - Chunqiao Tian
- NRG Statistical Center, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | | | - Ken Y Lin
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Kathleen Darcy
- NRG Statistical Center, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA.
| | | | - Daniel S Kapp
- Stanford University School of Medicine, Stanford, CA, USA.
| | - Bradley J Monk
- HonorHealth Research Institute, University of Arizona, Creighton University, Phoenix, AZ, USA.
| | | | | | - Larry Copeland
- Ohio State University Comprehensive Cancer Center, Columbus, OH, USA.
| | | | - Robert M Wenham
- Moffitt Cancer Center and Research Institute, Tampa, FL, USA.
| | - Neil Phippen
- Walter Reed National Military Medical Center, Bethesda, MD, USA.
| | | | | | - Mark Shahin
- Abington Memorial Hospital, Abington, PA, USA.
| | - Laurel Berry
- Wake Forest University Health Sciences, Winston-Salem, NC, USA.
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7
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Winkler SS, Tian C, Casablanca Y, Bateman NW, Jokajtys S, Kucera CW, Tarney CM, Chan JK, Richardson MT, Kapp DS, Liao CI, Hamilton CA, Leath CA, Reddy M, Cote ML, O'Connor TD, Jones NL, Rocconi RP, Powell MA, Farley J, Shriver CD, Conrads TP, Phippen NT, Maxwell GL, Darcy KM. Racial, ethnic and country of origin disparities in aggressive endometrial cancer histologic subtypes. Gynecol Oncol 2024; 184:31-42. [PMID: 38277919 DOI: 10.1016/j.ygyno.2024.01.009] [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: 10/23/2023] [Revised: 12/22/2023] [Accepted: 01/08/2024] [Indexed: 01/28/2024]
Abstract
OBJECTIVE This study investigated the risk of an aggressive endometrial cancer (EC) diagnosis by race, ethnicity, and country of origin to further elucidate histologic disparities in non-Hispanic Black (NHB), Hispanic, Asian/Pacific Islander (API), American Indian/Alaskan Native (AIAN) vs. non-Hispanic White (NHW) patients, particularly in Hispanic or API subgroups. METHODS Patient diagnosed between 2004 and 2020 with low grade (LG)-endometrioid endometrial cancer (ECC) or an aggressive EC including grade 3 EEC, serous carcinoma, clear cell carcinoma, mixed epithelial carcinoma, or carcinosarcoma in the National Cancer Database were studied. The odds ratio (OR) and 95% confidence interval (CI) for diagnosis of an aggressive EC histology was estimated using logistic modeling. RESULTS There were 343,868 NHW, 48,897 NHB, 30,013 Hispanic, 15,015 API and 1646 AIAN patients. The OR (95% CI) for an aggressive EC diagnosis was 3.07 (3.01-3.13) for NHB, 1.08 (1.06-1.11) for Hispanic, 1.17 (1.13-1.21) for API and 1.07 (0.96-1.19) for AIAN, relative to NHW patients. Subset analyses by country of origin illustrated the diversity in the OR for an aggressive EC diagnosis among Hispanic (1.18 for Mexican to 1.87 for Dominican), Asian (1.14 Asian Indian-Pakistani to 1.48 Korean) and Pacific Islander (1.00 for Hawaiian to 1.33 for Samoan) descendants. Hispanic, API and AIAN patients were diagnosed 5-years younger that NHW patients, and the risk for an aggressive EC histology were all significantly higher than NHW patients after correcting for age. Insurance status was another independent risk factor for aggressive histology. CONCLUSIONS Risk of an aggressive EC diagnosis varied by race, ethnicity, and country of origin. NHB patients had the highest risk, followed by Dominican, South/Central American, Cuban, Korean, Thai, Vietnamese, and Filipino descendants.
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Affiliation(s)
- Stuart S Winkler
- Division of Gynecologic Oncology, Department of Gynecologic Surgery and Obstetrics, Brooke Army Medical Center, San Antonio, TX, USA
| | - Chunqiao Tian
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; The Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, MD, USA
| | - Yovanni Casablanca
- Division of Gynecologic Oncology, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
| | - Nicholas W Bateman
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; The Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, MD, USA
| | - Suzanne Jokajtys
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Calen W Kucera
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Christopher M Tarney
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - John K Chan
- Palo Alto Medical Foundation, California Pacific Medical Center, Sutter Health, San Francisco, CA, USA
| | - Michael T Richardson
- Department of Obstetrics and Gynecology, University of California, Los Angeles School of Medicine, Los Angeles, CA. USA
| | - Daniel S Kapp
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA
| | - Cheng-I Liao
- Division of Obstetrics and Gynecology, Pingtung Veterans General Hospital, Pingtung, Taiwan
| | - Chad A Hamilton
- Gynecologic Oncology Section, Women's Services and The Ochsner Cancer Institute, Ochsner Health, New Orleans, LA, USA
| | - Charles A Leath
- Division of Gynecologic Oncology, University of Alabama at Birmingham, O'Neal Comprehensive Cancer Center, Birmingham, AL, USA
| | - Megan Reddy
- California Pacific Medical Center, San Francisco, CA, USA
| | - Michele L Cote
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indiana University, Indianapolis, IN, USA
| | - Timothy D O'Connor
- Institute for Genome Sciences, Department of Medicine, Program in Personalized and Genomic Medicine, University of Maryland School of Medicine, University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, MD, USA
| | - Nathaniel L Jones
- Division of Gynecologic Oncology, Mitchell Cancer Institute, University of South Alabama, Mobile, AL, USA
| | - Rodney P Rocconi
- Division of Gynecologic Oncology, Cancer Center & Research Institute, The University of Mississippi Medical Center, Jackson, MS, USA
| | - Matthew A Powell
- Division of Gynecologic Oncology, Siteman Cancer Center, Washington University, St Louis, MO, USA
| | - John Farley
- Division of Gynecologic Oncology, Center for Women's Health, Cancer Institute, Dignity Health St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Craig D Shriver
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Thomas P Conrads
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; Women's Health Integrated Research Center, Women's Service Line, Inova Health System, Falls Church, VA, USA
| | - Neil T Phippen
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - G Larry Maxwell
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; Women's Health Integrated Research Center, Women's Service Line, Inova Health System, Falls Church, VA, USA
| | - Kathleen M Darcy
- Gynecologic Cancer Center of Excellence, Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; The Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, MD, USA.
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8
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Richardson MT, Attwood K, Smith G, Liang SY, LaVigne Mager K, Tewari KS, Coleman RL, Kapp DS, Chan JK, Monk BJ. Sequential Targeted Therapy for Advanced, Metastatic, and Recurrent Cervical Cancer: A Cost-Effectiveness Analysis of the Patient Journey. Cancer Control 2023; 30:10732748231182795. [PMID: 37646470 PMCID: PMC10469236 DOI: 10.1177/10732748231182795] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023] Open
Abstract
OBJECTIVES To evaluate outcomes and cost-effectiveness of targeted therapy sequencing for metastatic and recurrent cervical cancer. METHOD Models were simulated based on phase II and III trials on bevacizumab (bev) from GOG-240, cemiplimab (cemi) from GOG 3016, pembrolizumab (pembro) from KEYNOTE-826, and tisotumab vedotin (tiso) from GOG 3023. Costs were based on IBM Micromedex RED BOOK™ and company listed costs. RESULTS For [chemo + bev → chemo], total cost was $125,918.04, with median overall survival (mOS) of 21.8 months, and cost-effectiveness ratio (CER) of $119,835.79. For [chemo + bev → cemi], total cost was $187,562.99 with mOS of 28.5 months and CER of $162,039.16. For [chemo + bev + pembro → chemo], total cost was $319,963.78 with mOS 32.9 months and CER of $249,930.10. For [chemo + bev + pembro → tiso], total cost was $455,204.45, with mOS 36.5 months and CER of $320,072.99. CONCLUSION The combination of immunotherapies and biologics have significantly increased overall survival, but with associated higher costs, primarily related to drug costs.
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Affiliation(s)
| | | | | | - Su-Ying Liang
- Sutter Health, Palo Alto Medical Foundation Research Institute, Palo Alto, CA, USA
| | | | | | | | - Daniel S. Kapp
- Stanford University School of Medicine, Stanford, CA, USA
| | - John K. Chan
- California Pacific Medical Center, Palo Alto Medical Foundation Research Institute, Palo Alto, CA, USA
| | - Bradley J. Monk
- Honor Health Research Institute, University of Arizona, Creighton University, Phoenix, AZ, USA
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9
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Richardson MT, Recouvreux MS, Karlan BY, Walts AE, Orsulic S. Ciliated Cells in Ovarian Cancer Decrease with Increasing Tumor Grade and Disease Progression. Cells 2022; 11:4009. [PMID: 36552773 PMCID: PMC9776429 DOI: 10.3390/cells11244009] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 11/23/2022] [Accepted: 12/08/2022] [Indexed: 12/14/2022] Open
Abstract
Ciliated cell markers expressed in epithelial ovarian cancers (EOC) are associated with improved survival. We examined the distribution of cells expressing ciliated cell markers in various EOC histologies and stages. Immunohistochemistry and/or multiplex immunofluorescence were used to determine the expression of FOXJ1 and/or CAPS (ciliated cell markers) in tissue microarrays including 4 normal fallopian tubes, 6 normal endometria, 16 cystadenomas, 25 borderline tumors, 21 low-grade carcinomas, and 118 high-grade carcinomas (HGSOC) (46 serous, 29 endometrioid, 30 clear cell, 13 mucinous). CAPS+ cells were observed in normal fallopian tubes and endometria and in ~85% of serous benign and borderline tumors and low-grade carcinomas but only in <40% of HGSOC. mRNA data from an independent cohort showed higher FOXJ1 and CAPS expression in serous borderline tumors and low-grade carcinomas compared to HGSOC. In HGSOC, ciliated cell-positive markers were observed in 52% primary tumors compared to 26% of patient-matched synchronous metastases, and 24% metachronous metastases (p = 0.009). mRNA data from an independent HGSOC cohort showed lower levels of CAPS in metastases than in primary tumors (p = 0.03). Overall, the study revealed that ciliated cells were less common in mucinous EOC, the percentage of ciliated cell marker-positive cases decreased with increasing grade, and the percentage of ciliated cells decreased in HGSOC metastases compared to patient-matched primary tumors.
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Affiliation(s)
- Michael T. Richardson
- Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Maria Sol Recouvreux
- Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Beth Y. Karlan
- Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA
- Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Ann E. Walts
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Sandra Orsulic
- Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA
- Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles, CA 90095, USA
- VA Greater Los Angeles Healthcare System, Los Angeles, CA 90095, USA
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10
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Chan JK, Tian C, Kesterson JP, Richardson MT, Lin K, Tewari KS, Herzog T, Kapp DS, Monk BJ, Casablanca Y, Hanjani P, Wenham RM, Walker J, McNally L, Copeland LJ, Robertson S, Lentz S, Spirtos NM, Bell JG. The clinical and prognostic significance of pre-chemotherapy serum CA-125 in high-risk early stage ovarian cancer: An NRG/GOG ancillary study. Gynecol Oncol 2022; 167:429-435. [PMID: 36244828 DOI: 10.1016/j.ygyno.2022.09.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 07/29/2022] [Revised: 09/23/2022] [Accepted: 09/28/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To determine the clinical and prognostic significance of CA-125 trends prior to, during, and after chemotherapy in high-risk early-stage epithelial ovarian cancer patients. METHODS All patients were enrolled in a phase III randomized trial (GOG 157) following upfront surgery for grade 3 stage IA/IB, stage IC, or stage II disease, and had been treated with either three or six cycles of carboplatin/paclitaxel. Kaplan-Meier method and Cox proportional hazards model were used to evaluate recurrence-free survival (RFS) and overall survival (OS). RESULTS Of 350 patients, the median pre-chemotherapy CA-125 was 65 (IQR: 31-129). 71% of Whites had an elevated CA-125 compared to 47% of non-Whites (p = 0.006). Following the first cycle of chemotherapy, 74% of those with elevated CA-125 had normalization. Those who had normalization of CA-125 after 1 cycle had significantly better 5-year RFS (81% vs. 65%, p = 0.003) and OS (87% vs. 75%, p = 0.009) compared to those who did not normalize (defined as ≤35 U/mL). The pattern of CA-125 change following chemotherapy cycle 1, from normal to normal vs. elevated to normal vs. elevated to elevated had corresponding RFS of 87% vs. 80% vs. 68% (p = 0.013), and OS of 92% vs. 88% vs. 77% (p = 0.009). However, the percent decline (p = 0.993) and absolute nadir normal value of CA-125 (0-10 vs. 11-35 U/mL) were not predictive of outcome (p = 0.4). CONCLUSIONS Normal baseline CA125 and normalization of this biomarker after the first cycle of chemotherapy were associated with better survival in high-risk early-stage epithelial ovarian cancer patients.
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Affiliation(s)
- John K Chan
- Division of Gynecologic Oncology, California Pacific Medical Center, Palo Alto Medical Foundation Research Institute, Palo Alto, CA, United States of America.
| | - Chunqiao Tian
- Division of Gynecologic Oncology, Uniformed Services University of the Health Sciences, Bethesda, MD, United States of America
| | - Joshua P Kesterson
- Division of Gynecologic Oncology, Penn State Health Milton Hershey Medical Center, Hershey, United States of America
| | - Michael T Richardson
- Division of Gynecologic Oncology, University of California, Los Angeles, Los Angeles, CA, United States of America
| | - Ken Lin
- Division of Gynecologic Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States of America
| | - Krishnansu S Tewari
- Division of Gynecologic Oncology, University of California, Irvine Medical Center, Orange, CA, United States of America
| | - Thomas Herzog
- Division of Gynecologic Oncology, University of Cincinnati Cancer Institute, Cincinnati, OH, United States of America
| | - Daniel S Kapp
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, United States of America
| | - Bradley J Monk
- Division of Gynecologic Oncology, Arizona Oncology, University of Arizona College of Medicine, Creighton University School of Medicine at St. Joseph's Hospital, Phoenix, AZ, United States of America
| | - Yovanni Casablanca
- Division of Gynecologic Oncology, Walter Reed National Military Medical Center, MD, United States of America
| | - Parviz Hanjani
- Division of Gynecologic Oncology, Abington Memorial Hospital- Asplundh Cancer Pavilion, Abington, PA, United States of America
| | - Robert M Wenham
- Division of Gynecologic Oncology, Moffitt Cancer Center Institute and Research Institute, Tampa, FL, United States of America
| | - Joan Walker
- Division of Gynecologic Oncology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States of America
| | - Leah McNally
- Division of Gynecologic Oncology, Duke University Medical Center. Durham, NC, United States of America
| | - Larry J Copeland
- Division of Gynecologic Oncology, Ohio State University Comprehensive Cancer Center, OH, United States of America
| | - Sharon Robertson
- Division of Gynecologic Oncology, Indiana University Hospital/Melvin and Bren Simon Cancer Center, IN, United States of America
| | - Samuel Lentz
- Division of Gynecologic Oncology, Wake Forest University Health Sciences, NC, United States of America
| | - Nick M Spirtos
- Division of Gynecologic Oncology, Women's Cancer Center of Nevada, LV, United States of America
| | - Jeffery G Bell
- Division of Gynecologic Oncology, Ohio Riverside Methodist Hospital, Columbus, OH, United States of America
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11
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DiTosto JD, Steinberg JR, Turner BE, Weeks BT, Young AMP, Lu CF, Wolgemuth T, Holder K, Laasiri N, Squires NA, Anderson JN, Zhang N, Richardson MT, Magnani CJ, Perry MF, Yee LM. How many US obstetrical trials reach publication? A cross-sectional analysis of ClinicalTrials.gov and PubMed from 2007 to 2019. Am J Obstet Gynecol MFM 2022; 4:100696. [PMID: 35872356 DOI: 10.1016/j.ajogmf.2022.100696] [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: 05/31/2022] [Revised: 07/14/2022] [Accepted: 07/18/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Obstetrical clinical trials are the foundation of evidence-based medicine during pregnancy. As more obstetrical trials are conducted, understanding the publication characteristics of these trials is of utmost importance to advance obstetrical health. OBJECTIVE This study aimed to characterize the frequency of publication and trial characteristics associated with publication among obstetrical clinical trials in the United States. We additionally sought to examine time from trial completion to publication. STUDY DESIGN This was a cross-sectional analysis of completed obstetrical trials with an intervention design and at least 1 site in the United States registered to ClinicalTrials.gov from 2007 to 2019. Trial characteristics were cross-referenced with PubMed to determine publication status up to 2021 using the National Clinical Trial identification number. Bivariable analyses were conducted to determine trial characteristics associated with publication. Multivariable logistic regression models controlling for prespecified covariates were generated to estimate the relationship between funding, primary purpose, and therapeutic foci with publication. Additional exploratory analyses of other trial characteristics were conducted. Time to publication was analyzed using Kaplan-Meier curves and Cox regression models. RESULTS Of the 1879 obstetrical trials with registered completion, a total of 575 (30.6%) had at least 1 site in the United States, were completed before October 1, 2019, and were included in this analysis. Between October 2007 and October 2019, fewer than two-thirds (N=348, 60.5%) of trials reached publication. Annual rates of publication ranged from 46.4% in 2018 to 70.0% in 2007. No difference was observed in publication by funding, primary purpose, or therapeutic foci (all P>.05). Trials with characteristics indicating high trial quality-including randomized allocation scheme, ≥50 participants enrolled, ≥2 sites, and presence of a data safety monitoring committee-had increased odds of publication compared with those without such characteristics (all P<.05). For example, studies with randomized allocation of intervention had 2-fold greater odds of publication than nonrandomized studies (adjusted odds ratio, 2.09; 95% confidence interval, 1.30-3.37). Studies with ≥150 participants had nearly 8-fold odds of publication (adjusted odds ratio, 7.90; 95% confidence interval, 3.78-17.49) relative to studies with <50 participants. Temporal analysis demonstrated variability in time to publication among obstetrical trials, with a median time of 20.1 months after trial completion, and with most trials that reached publication having been published by 40 months. No difference was observed in time to publication by funding, primary purpose, or therapeutic foci (all P>.05). CONCLUSION Publication of obstetrical trials remains suboptimal, with significant differences observed between trials with indicators of high quality and those without. Most trials that reach publication are published within 2 years of registered completion on ClinicalTrials.gov.
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Affiliation(s)
- Julia D DiTosto
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL (Ms DiTosto, Drs Steinberg, Young, Lu, and Wolgemuth, Ms Holder, and Drs Squires, Perry, and Yee)
| | - Jecca R Steinberg
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL (Ms DiTosto, Drs Steinberg, Young, Lu, and Wolgemuth, Ms Holder, and Drs Squires, Perry, and Yee)
| | - Brandon E Turner
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA (Dr Turner)
| | - Brannon T Weeks
- Integrated Residency Program in Obstetrics and Gynecology, Brigham and Women's Hospital-Massachusetts General Hospital, Boston, MA (Dr Weeks)
| | - Anna Marie P Young
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL (Ms DiTosto, Drs Steinberg, Young, Lu, and Wolgemuth, Ms Holder, and Drs Squires, Perry, and Yee)
| | - Connie F Lu
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL (Ms DiTosto, Drs Steinberg, Young, Lu, and Wolgemuth, Ms Holder, and Drs Squires, Perry, and Yee)
| | - Tierney Wolgemuth
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL (Ms DiTosto, Drs Steinberg, Young, Lu, and Wolgemuth, Ms Holder, and Drs Squires, Perry, and Yee)
| | - Kai Holder
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL (Ms DiTosto, Drs Steinberg, Young, Lu, and Wolgemuth, Ms Holder, and Drs Squires, Perry, and Yee)
| | - Nora Laasiri
- Northwestern University Physician Assistant Program, Northwestern University Feinberg School of Medicine, Chicago, IL (Ms Laasiri)
| | - Natalie A Squires
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL (Ms DiTosto, Drs Steinberg, Young, Lu, and Wolgemuth, Ms Holder, and Drs Squires, Perry, and Yee)
| | - Jill N Anderson
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA (Dr Anderson)
| | - Naixin Zhang
- Department of Obstetrics and Gynecology, The University of Tennessee Health Science Center, Memphis, TN (Dr Zhang)
| | - Michael T Richardson
- Department of Obstetrics and Gynecology, University of California, Los Angeles, Los Angeles, CA (Dr Richardson)
| | - Christopher J Magnani
- Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (Dr Magnani)
| | - Madeline F Perry
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL (Ms DiTosto, Drs Steinberg, Young, Lu, and Wolgemuth, Ms Holder, and Drs Squires, Perry, and Yee)
| | - Lynn M Yee
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL (Ms DiTosto, Drs Steinberg, Young, Lu, and Wolgemuth, Ms Holder, and Drs Squires, Perry, and Yee).
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Liang S, Richardson MT, Wong D, Chen T, Colocci N, Kapp DS, de Bruin M, Kurian A, Chan J. The effect of COVID-19 on telehealth: Next steps in a post-pandemic life. Int J Gynaecol Obstet 2022; 159:996-997. [PMID: 35976039 PMCID: PMC9538136 DOI: 10.1002/ijgo.14411] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 07/14/2022] [Accepted: 08/02/2022] [Indexed: 11/07/2022]
Abstract
Older patients and those who require interpreters are least likely to use telehealth for gynecologic oncology care, showing disparities which continued after statewide vaccinations.
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Affiliation(s)
| | - Michael T. Richardson
- Department of Obstetrics and GynecologyUniversity of California Los AngelesLos AngelesCaliforniaUSA
| | - Deanna Wong
- Department of Obstetrics and GynecologyUniversity of California Los AngelesLos AngelesCaliforniaUSA
| | - Tony Chen
- Sutter HealthSan FranciscoCaliforniaUSA
| | | | - Daniel S. Kapp
- Stanford University School of MedicinePalo AltoCaliforniaUSA
| | | | - Allison Kurian
- Stanford University School of MedicinePalo AltoCaliforniaUSA
| | - John K. Chan
- Sutter HealthSan FranciscoCaliforniaUSA,Division of Gynecologic OncologyCalifornia Pacific/Palo Alto/Sutter Health Research InstituteSan FranciscoCaliforniaUSA
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Chan JE, Caesar MA, Mann AK, Koh-Bell A, Richardson MT, Johnson CR, Kapp DS, Chan JK. The Role of Diet Compared to Physical Activity on Women's Cancer Mortality: Results From the Third National Health and Nutrition Examination Survey. Front Public Health 2022; 10:853636. [PMID: 35979450 PMCID: PMC9376675 DOI: 10.3389/fpubh.2022.853636] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 06/20/2022] [Indexed: 11/21/2022] Open
Abstract
Background Among women in the United States, cancer is the second leading cause of death. Prior studies have examined how lifestyle factors, such as diet and physical activity, influence cancer mortality. However, few have evaluated if diet or physical activity has a stronger protective effect for cancer mortality. Therefore, this study aims to evaluate and compare the impacts of diet and physical activity on women's cancer mortality. Methods Prospective, cross-sectional data were abstracted from the Third US National Health and Nutrition Examination Survey (NHANES III) on female respondents from 1988 to 1994. Physical activity was derived from the CDC's metabolic equivalent (MET) intensity levels. Dietary classifications were derived from the USDA's healthy eating index (HEI). We utilized the National Death Index to obtain mortality follow-up information on our cohort until December 31, 2015. Chi-squared, multivariable Cox regression, and Kaplan–Meier estimates were employed for statistical analyses. Results Of 3,590 women (median age: 57, range: 40–89), 30% had an obese BMI (BMI≥30 kg/m2). Additionally, 22% of participants self-reported a healthy diet, 69% needed dietary improvement, and 9% had a poor diet. Furthermore, 21% reported physical inactivity, 44% did not meet physical activity guidelines, and 35% met guidelines. On multivariate analysis, healthy diet (HR: 0.70; 95% CI: 0.51–0.98; p = 0.04), but not physical activity (HR: 0.87; 95% CI: 0.55–1.38; p = 0.55), independently predicted for lower cancer mortality. Participants with a healthy diet but low exercise had decreased cancer mortality compared to participants with an unhealthy diet but high exercise (p = 0.01). Conclusions A healthful diet was associated with lower cancer mortality in women, even after adjusting for obesity, inflammation, and other covariates. In addition, diet may play a stronger role in reducing cancer mortality in women than physical activity.
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Affiliation(s)
- Joshua E. Chan
- Department of Microbiology and Immunology, Stanford University School of Medicine, Stanford, CA, United States
| | - Michelle Ann Caesar
- Department of Obstetrics and Gynecology, California Pacific Medical Center Research Institute, San Francisco, CA, United States
| | - Amandeep K. Mann
- Palo Alto Medical Foundation Research Institute, Palo Alto, CA, United States
| | - Alex Koh-Bell
- California Pacific Medical Center, San Francisco, CA, United States
| | - Michael T. Richardson
- Department of Obstetrics and Gynecology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Caitlin R. Johnson
- Department of Obstetrics and Gynecology, California Pacific Medical Center Research Institute, San Francisco, CA, United States
| | - Daniel S. Kapp
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, United States
| | - John K. Chan
- California Pacific Medical Center, San Francisco, CA, United States
- *Correspondence: John K. Chan
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Steinberg JR, Turner BE, DiTosto JD, Young AMP, Magnani CJ, Zhang N, Lu CF, Wolgemuth T, Laasiri N, Holder K, Weeks BT, Richardson MT, Anderson JN, Squires N, Yee LM. Race in US obstetric clinical trials: An analysis of reporting and representation from 2007-2020. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.761] [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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Steinberg JR, Weeks BT, Reyes GA, Conway Fitzgerald A, Zhang WY, Lindsay SE, Anderson JN, Chan K, Richardson MT, Magnani CJ, Igbinosa I, Girsen A, El-Sayed YY, Turner BE, Lyell DJ. The obstetrical research landscape: a cross-sectional analysis of clinical trials from 2007-2020. Am J Obstet Gynecol MFM 2020; 3:100253. [PMID: 33043288 PMCID: PMC7537600 DOI: 10.1016/j.ajogmf.2020.100253] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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] [Received: 09/24/2020] [Accepted: 09/26/2020] [Indexed: 01/17/2023]
Abstract
Background Obstetrical complications affect more than a third of women globally, but are underrepresented in clinical research. Little is known about the comprehensive obstetrical clinical trial landscape, how it compares with other fields, or factors associated with the successful completion of obstetrical trials. Objective This study aimed to characterize obstetrical clinical trials registered on ClinicalTrials.gov with the primary objective of identifying features associated with early discontinuation and results reporting. Study Design This is a cross-sectional study with descriptive, logistic regression and Cox regression analyses of clinical trials registered on ClinicalTrials.gov. Our primary exposure variables were trial focus (obstetrical or nonobstetrical) and trial funding (industry, United States government, or academic). We conducted additional exploratory analyses of other trial features including design, enrollment, and therapeutic focus. We examined the associations of exposure variables and other trial features with 2 primary outcomes: early discontinuation and results reporting. Results We downloaded data for all studies (N=332,417) registered on ClinicalTrials.gov from October 1, 2007, to March 9, 2020, from the Aggregate Analysis of ClinicalTrials.gov database. We excluded studies with a noninterventional design (n=63,697) and those registered before October 1, 2007 (n=45,209). A total of 4276 obstetrical trials (1.9%) (ie, interventional studies) and 219,235 nonobstetric trials (98.1%) were compared. Among all trials, 2.8% of academic-funded trials, 1.9% of United States government–funded trials, and 0.4% of industry-funded trials focused on obstetrics. The quantity of obstetrical trials increased over time (10.8% annual growth rate). Compared with nonobstetrical trials, obstetrical trials had a greater risk of early discontinuation (adjusted hazard ratio, 1.40; 95% confidence interval, 1.21–1.62; P<.0001) and similar odds of results reporting (adjusted odds ratio, 0.89; 95% confidence interval, 0.72–1.10; P=.19). Among obstetrical trials funders after controlling for confounding variables, United States government–funded trials were at the lowest risk of early discontinuation (United States government, adjusted hazard ratio, 0.23; 95% confidence interval, 0.07–0.69; P=.009; industry reference; academic, adjusted hazard ratio, 1.04; 95% confidence interval, 0.62–1.74; P=.88). Academic-funded trials had the lowest odds of results reporting after controlling for confounding variables (academic institutions, adjusted odds ratio, 0.39; 95% confidence interval, 0.22–0.68; P=.0009; industry reference; United States government, adjusted odds ratio, 1.06; 95% confidence interval, 0.53–2.09; P=.87). Conclusion Obstetrical trials represent only 1.9% of all clinical trials in ClinicalTrials.gov and have comparatively poor completion. All stakeholders should commit to increasing the number of obstetrical trials and improving their completion and dissemination to ensure clinical research reflects the obstetrical burden of disease and advances maternal health.
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Affiliation(s)
- Jecca R Steinberg
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL.
| | - Brannon T Weeks
- Department of Obstetrics and Gynecology, Stanford Medical School, Stanford, CA
| | - Griselda A Reyes
- Department of Obstetrics & Gynecology, University of California, Irvine, Orange, CA
| | | | - Wendy Y Zhang
- Department of Obstetrics & Gynecology, University of California, Irvine, Orange, CA
| | - Sarah E Lindsay
- Department of Obstetrics and Gynecology, Stanford Medical School, Stanford, CA
| | - Jill N Anderson
- Department of Obstetrics and Gynecology, Stanford Medical School, Stanford, CA
| | - Katelyn Chan
- Department of Obstetrics and Gynecology, Stanford Medical School, Stanford, CA
| | - Michael T Richardson
- Department of Obstetrics and Gynecology, University of California, Los Angeles, Los Angeles, CA
| | | | - Irogue Igbinosa
- Department of Obstetrics and Gynecology, Stanford Medical School, Stanford, CA
| | - Anna Girsen
- Department of Obstetrics and Gynecology, Stanford Medical School, Stanford, CA
| | - Yasser Y El-Sayed
- Department of Obstetrics and Gynecology, Stanford Medical School, Stanford, CA
| | - Brandon E Turner
- Department of Obstetrics and Gynecology, Stanford Medical School, Stanford, CA
| | - Deirdre J Lyell
- Department of Obstetrics and Gynecology, Stanford Medical School, Stanford, CA
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Vaz J, Tian C, Richardson MT, Chan JK, Mysona D, Rao UN, Powell MA, Shriver CD, Hamilton CA, Casablanca Y, Maxwell GL, Darcy KM. Impact of adjuvant treatment and prognostic factors in stage I uterine leiomyosarcoma patients treated in Commission on Cancer®-accredited facilities. Gynecol Oncol 2020; 157:121-130. [PMID: 31954536 DOI: 10.1016/j.ygyno.2019.12.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 09/05/2019] [Revised: 11/29/2019] [Accepted: 12/06/2019] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Determine the impact of adjuvant chemotherapy (ACT) and prognostic factors in surgically managed patients with stage I uterine leiomyosarcoma (ULMS). METHODS Women who underwent hysterectomy and were diagnosed with stage I ULMS between 2010 and 2014 in the National Cancer Database were eligible for this observation study. Inverse probability of treatment weighting based on propensity score was used to balance clinical characteristics between ACT and no ACT patients. Hazard ratio (HR) and 95% confidence interval (CI) were estimated from Cox modeling. RESULTS There were 1059 eligible patients with stage I ULMS including 514 treated with ACT and 545 with no ACT. Patient characteristics and tumor features varied in patients treated with ACT vs. no ACT (P < .0001). Multivariate survival analysis demonstrated that patient age, comorbidity score, tumor size, lymphovascular space invasion (LVSI) and grade were independent prognostic factors. After propensity score weighting to control for imbalance of prognostic clinical factors, adjusted five-year survival was 61.7% vs. 61.3% and restricted mean survival time was 39.7 vs. 40.6 months for ACT vs. no ACT, respectively. Risk of death in a weighted Cox analysis of overall survival was similar (HR = 1.08, 95% CI = 0.85-1.37, P = .054) for ACT vs. no ACT patients. Subset analysis demonstrated that survival was similar in ACT vs. no ACT patients categorized by age, tumor size and LVSI or with high grade or ungraded tumors. In contrast, patients with low grade tumors had worse 5-year survival (82.3% vs. 91.5%) and an increased risk of death (HR = 3.79, 95% CI = 1.15-12.40, P = .028) following ACT vs. no ACT. CONCLUSIONS ACT did not improve survival over no ACT in patients with stage I ULMS and was inferior in patients with low grade tumors.
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Affiliation(s)
- Jennifer Vaz
- Department of Obstetrics and Gynecology, Inova Fairfax Hospital, Falls Church, VA, USA.
| | - Chunqiao Tian
- Gynecologic Cancer Center of Excellence, Department of Obstetrics & Gynecology, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; The Henry M Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA.
| | | | - John K Chan
- Palo Alto Medical Foundation, California Pacific Medical Center, Sutter Health, San Francisco, CA, USA.
| | - David Mysona
- Medical College of Georgia and College of Allied Health Sciences, Augusta University, Augusta, GA, USA.
| | - Uma N Rao
- Gynecologic Cancer Center of Excellence, Department of Obstetrics & Gynecology, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; The Henry M Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA; Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
| | - Matthew A Powell
- Division of Gynecologic Oncology and Siteman Cancer Center, Washington University, St Louis, MO, USA.
| | - Craig D Shriver
- John P Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
| | - Chad A Hamilton
- Department of Obstetrics and Gynecology, Inova Fairfax Hospital, Falls Church, VA, USA; Gynecologic Cancer Center of Excellence, Department of Obstetrics & Gynecology, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; John P Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, MD, USA; Inova Schar Cancer Institute, Inova Center for Personalized Health, Falls Church, VA, USA.
| | - Yovanni Casablanca
- Gynecologic Cancer Center of Excellence, Department of Obstetrics & Gynecology, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; John P Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
| | - G Larry Maxwell
- Department of Obstetrics and Gynecology, Inova Fairfax Hospital, Falls Church, VA, USA; Gynecologic Cancer Center of Excellence, Department of Obstetrics & Gynecology, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; John P Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, MD, USA; Inova Schar Cancer Institute, Inova Center for Personalized Health, Falls Church, VA, USA.
| | - Kathleen M Darcy
- Gynecologic Cancer Center of Excellence, Department of Obstetrics & Gynecology, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; The Henry M Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA; John P Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
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Tijerina JD, Morrison SD, Nolan IT, Parham MJ, Richardson MT, Nazerali R. Celebrity Influence Affecting Public Interest in Plastic Surgery Procedures: Google Trends Analysis. Aesthetic Plast Surg 2019; 43:1669-1680. [PMID: 31392394 DOI: 10.1007/s00266-019-01466-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 07/17/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Medical decisions made by celebrities have a profound influence on medical decisions made by the general population. Google Trends (GT) is a free, online resource with virtually no barriers to use that allows for tracking of global search volumes as a proxy for determining public interest. In this study, we utilize GT to characterize the significant and measurable effects that the May 2013 announcement of Angelina Jolie's BRCA-influenced prophylactic mastectomy, May 2015 announcement of Kylie Jenner's lip augmentation, April 2017 announcement of Caitlyn Jenner's gender affirming surgery and February 2014 media attention given to Kim Kardashian's rumored buttock augmentation had on corresponding surgical procedure volumes. METHODS GT databases of search volumes were collected for terms related to prophylactic mastectomy, lip augmentation, gender affirming surgery and buttock augmentation categories from January 2004 to March 2019 using the "related queries" feature. Mean search volumes prior to respective announcements were compared to that of the period starting 6 months after. Additionally, the percent change from the month preceding respective celebrity announcements was compared to the month of the announcement for each search term. RESULTS For mastectomy, all terms demonstrated peak interest during May 2013. Following Jolie's announcement, interest in "mastectomy" rose 1328%, "prophylactic mastectomy" rose 324%, "BRCA1" rose 316%, "BRCA2" rose 138% and "BRCA gene" rose 354%. Long-term interest was higher after May 2013 than beforehand for all terms except "prophylactic mastectomy" (each, p < 0.001). Following Kylie Jenner's announcement, interest in "lip augmentation" rose 43%, "lip enhancement" rose 37%, "lip fillers" rose 3233%, "lip implants" rose 8% and "lip injections" rose 13%. Long-term interest was higher after May 2015 than beforehand for all terms except "lip augmentation" and "lip enhancement" (each, p < 0.001). Following Caitlyn Jenner's announcement, "gender affirming surgery" rose 119%, "gender reassignment" rose 186%, "gender reassignment surgery" rose 203% and "transgender surgery" rose 35%. Long-term interest was higher after April 2017 than beforehand for all terms except "sex change" (each, p < 0.001). Following Kardashian's rumored injections, interest in "butt enhancement" rose 34% and "butt implants" rose 100%. Long-term interest was higher after February 2014 than beforehand for all terms (each, p < 0.001). CONCLUSIONS GT data trends correlate with shifts in real-world healthcare utilization and healthcare-related public interest caused by high-profile public events, making it a useful tool for real-time prediction of trends in public health in response to a variety of observable influences. LEVEL OF EVIDENCE V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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Greenberg DR, Richardson MT, Tijerina JD, Bass MB, Eisenberg ML. The Quality of Systematic Reviews and Meta-Analyses in Erectile Dysfunction Treatment and Management Published in the Sexual Medicine Literature. J Sex Med 2019; 16:394-401. [DOI: 10.1016/j.jsxm.2019.01.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 01/10/2019] [Accepted: 01/12/2019] [Indexed: 02/08/2023]
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Alagappan M, Richardson MT, Schoen MK, Muffly L, Tierney K, Jenkins P, Neri E, Kraemer HC, Periyakoil VS. A Three-Step Letter Advance Directive Procedure to Facilitate Patient-Proxy Alignment in Advance Care Planning. J Palliat Med 2018; 21:1749-1754. [PMID: 30247088 DOI: 10.1089/jpm.2018.0150] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 11/13/2022] Open
Abstract
Background: Little is known about the extent of alignment between hematopoietic stem cell transplant (HSCT) patients and their healthcare proxies with respect to advance care planning (ACP). Aim: To determine if a structured three-step process using the letter advance directive (LAD) could (1) allow for the differences in opinion between patient-proxy dyads to surface and (2) help bridge preexisting discordance about specific treatment choices. Design: Blinded to each other, the HSCT patient (LAD-1) and proxy (LAD-2) each completed the LAD (step 1). They unmasked, compared LAD-1 and LAD-2, and discussed their choices (step 2). They completed a final letter directive (LAD-3) by consensus (step 3). Settings/Participants: Convenience sample of eighty dyads (patient and proxy) at a regional HSCT referral center. Results: The mean patient-proxy concordance was 72.9% for the 12 questions in the LAD. Wanting to be pain free at the end of life was the statement with the most amount of agreement (88.75% in LAD-1, 91.25% in LAD-2, and 90% in LAD-3). Patient-proxy dyads had notable discordance related to specific treatments. The highest discordance was related to ventilator support (46.3% of patients refused it, while 58.8% of proxies refused on behalf of the patient). Overall, proxies were more likely than patients to opt in for dialyses and hospice care but more likely to opt out for cardiac resuscitation and sedation to palliate refractory symptoms. On open discussion, patient-proxy discordance mostly resolved in favor of the patient. Conclusions: The ACP process should allow for patient-proxy differences to surface, facilitate a discussion about the granular details with the goal of reaching consensus. Our three-step approach using the LAD is an effective way to identify areas of patient-proxy concordance and discordance about specific treatment preferences. A structured patient-proxy discussion using the LAD helped reconcile discordance and most often in favor of a patient's original wishes.
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Affiliation(s)
- Muthuraman Alagappan
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | | | | | - Lori Muffly
- Stanford University School of Medicine, Stanford, California
| | | | | | - Eric Neri
- Stanford University School of Medicine, Stanford, California
| | | | - Vyjeyanthi S Periyakoil
- Stanford University School of Medicine, Stanford, California.,VA Palo Alto Health Care System, Palo Alto, California
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Richardson MT, Backhus LM, Berry MF, Vail DG, Ayers KC, Benson JA, Bhandari P, Teymourtash M, Shrager JB. Intraoperative costs of video-assisted thoracoscopic lobectomy can be dramatically reduced without compromising outcomes. J Thorac Cardiovasc Surg 2017; 155:1267-1277.e1. [PMID: 29224839 DOI: 10.1016/j.jtcvs.2017.08.146] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 08/11/2017] [Accepted: 08/25/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine whether surgeon selection of instrumentation and other supplies during video-assisted thoracoscopic lobectomy (VATSL) can safely reduce intraoperative costs. METHODS In this retrospective, cost-focused review of all video-assisted thoracoscopic surgery anatomic lung resections performed by 2 surgeons at a single institution between 2010 and 2014, we compared VATSL hospital costs and perioperative outcomes between the surgeons, as well as costs of VATSL compared with thoracotomy lobectomy (THORL). RESULTS A total of 100 VATSLs were performed by surgeon A, and 70 were performed by surgeon B. The preoperative risk factors did not differ significantly between the 2 groups of surgeries. Mean VATSL total hospital costs per case were 24% percent greater for surgeon A compared with surgeon B (P = .0026). Intraoperative supply costs accounted for most of this cost difference and were 85% greater for surgeon A compared with surgeon B (P < .0001). The use of nonstapler supplies, including energy devices, sealants, and disposables, drove intraoperative costs, accounting for 55% of the difference in intraoperative supply costs between the surgeons. Operative time was 25% longer for surgeon A compared with surgeon B (P < .0001), but this accounted for only 11% of the difference in total cost. Surgeon A's overall VATSL costs per case were similar to those of THORLs (n = 100) performed over the same time period, whereas surgeon B's VATSL costs per case were 24% less than those of THORLs. On adjusted analysis, there was no difference in VATSL perioperative outcomes between the 2 surgeons. CONCLUSIONS The costs of VATSL differ substantially among surgeons and are heavily influenced by the use of disposable equipment/devices. Surgeons can substantially reduce the costs of VATSL to far lower than those of THORL without compromising surgical outcomes through prudent use of costly instruments and technologies.
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Affiliation(s)
| | - Leah M Backhus
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif
| | - Mark F Berry
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif
| | - Daniel G Vail
- Stanford University School of Medicine, Stanford, Calif
| | - Kelsey C Ayers
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif
| | - Jalen A Benson
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif
| | - Prasha Bhandari
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif
| | | | - Joseph B Shrager
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif.
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Zhang Y, Carter SJ, Schumacker RE, Neggers YH, Curtner-Smith, MD, Richardson MT, Green JM, Bishop PA. Effect of caffeine ingestion on fluid balance during exercise in the heat and during recovery. S Afr J SM 2014. [DOI: 10.17159/2413-3108/2014/v26i2a395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background. The effect of ingestion of a common stimulant, caffeine, on fluid balance during exercise and recovery is not fully known. Objectives. To determine the effect of caffeine on fluid balance during exercise in the heat and during a 3-hour recovery period thereafter. Methods. In a randomised, controlled design, caffeine-naive participants (N=8) pedalled on a bike to achieve 2.5% baseline body mass loss in a hot environment in four separate conditions: with (C+) or without (C–) caffeine ingestion (6 mg/kg of body mass) prior to exercise, followed by (W+) or without (W–) 100% fluid replenishment (water) of the body mass loss during a 3-hour recovery period (yielding C+W+, C+W–, C–W+ and C–W–, respectively). Results. Mean (standard deviation) urine production was not different (p>0.05) regardless of rehydration status: 230 (162) mL (C+W–) v. 168 (77) mL (C–W–); and 713 (201) mL (C+W+) v. 634 (185) mL (C–W+). For the 3-hour recovery, caffeine ingestion caused higher hypohydration during rehydration conditions (p=0.02), but practically the mean difference in the loss of body mass was only 0.2 kg. Conclusion. In practical terms, there was no evidence that caffeine ingestion in moderation would impair fluid balance during prolonged exercise in the heat or during 3 hours of recovery.
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Laurent CM, Green JM, Bishop PA, Sjökvist J, Schumacker RE, Richardson MT, Curtner-Smith M. Effect of gender on fatigue and recovery following maximal intensity repeated sprint performance. J Sports Med Phys Fitness 2010; 50:243-253. [PMID: 20842083] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
AIM This study investigated the effects of gender on repeated, maximal-intensity intermittent sprint exercise following variable day-to-day recovery periods. METHODS Sixteen volunteers (8 men, 8 women) performed four trials of high-intensity intermittent sprint exercise consisting of three bouts of eight 30 m sprints (total of 24 sprints). Following completion of the baseline trial, in repeated-measures design, participants were assigned, in counter-balanced order, variable recovery periods of 24, 48, and 72 h whereupon they repeated an identical exercise trial. RESULTS Results from a series of 4 (trial) x 3 (bout) repeated measures ANOVAs revealed men produced significantly (P < 0.01) faster times throughout all bouts and trials of repeated sprint exercise. Additionally, women exhibited significantly lower (P < 0.05) blood lactate concentration and significantly lower (P < 0.05) decrement in performance, indicating increased resistance to fatigue during repeated exercise sessions. There were no significant differences (P > 0.05) between genders for heart rate or rating of perceived exertion during or following trials. There were no significant differences for overall sprint performance within either gender among trials. CONCLUSION These results indicate men, while able to produce higher absolute power outputs (i.e., lower sprint time), demonstrate higher decrement scores within a trial compared to women, thus suggesting women may recover faster and fatigue less. Also, gender differences affecting recovery within in a trial were observed to be diminished between trials (i.e., day-to-day recovery) of maximal intermittent sprint work evidenced by the observed stability of performance between trials following various recovery durations.
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Affiliation(s)
- C M Laurent
- Department of Kinesiology, St. Ambrose University, Davenport, IA 52803, USA.
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Wickwire PJ, Bishop PA, Green JM, Richardson MT, Lomax RG, Casaru C, Curtner-Smith M. Physiological and comfort effects of a commercial "cooling cap" worn under protective helmets. J Occup Environ Hyg 2009; 6:455-459. [PMID: 19412861 DOI: 10.1080/15459620902959377] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Ballistic protective helmets can impair heat dissipation. A cooling device in the helmet (cooling pad, CP) could help prevent heat problems in military personnel and potentially enhance comfort. This study examined the effects of CP on rectal and skin temperatures, heart rate, percent change in plasma volume, urine specific gravity, rating of perceived exertion, and other subjective measures while performing light work in a hot environment. It was hypothesized that the CP would act as an insulator to the head, which would not positively affect any physiological variable but could positively affect wearer subjective comfort or temperature. Participants performed a work protocol for approximately 2 hr. A ballistic vest, slacks, short-sleeved button-up shirt, and a ballistic helmet (one trial with CP and one trial without) were worn. Repeated measures analysis of variance (ANOVA) showed no differences (p > 0.05) between wearing and not wearing the CP for any physiological parameter. However, participants perceived the CP as cooler (p = 0.002). Other trends in perceptual data such as thermal strain and helmet comfort indicated the CP felt cooler. However, based on forehead temperature and participant comments, the CP lost its cooling ability relatively quickly (within approximately 30 min).
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Affiliation(s)
- P J Wickwire
- Kennesaw State University, Department of Health, Physical Education, and Sport Science, Kennesaw, Georgia 30144, USA.
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Wickwire J, Bishop PA, Green JM, Richardson MT, Lomax RG, Casaru C, Jones E, Curtner-Smith M. Validation of a personal fluid loss monitor. Int J Sports Med 2007; 29:139-44. [PMID: 17960503 DOI: 10.1055/s-2007-965319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Dehydration raises heat injury risk and reduces performance [ , , ]. The purpose was to validate the Hydra-Alert Jr (Acumen). The Hydra-Alert was tested in two exercise/clothing conditions. Participants wore it while wearing exercise clothing and exercising at a self-selected intensity (n = 8). Others wore the Hydra-Alert while wearing a ballistic-vest and performing an industrial-protocol (n = 8). For each condition, the Hydra-Alert was tested on two occasions (T1 and T2). The Hydra-Alert was tested against nude weight loss for both conditions. The Hydra-Alert had low test-retest reliability for both conditions (average absolute value of the error between Hydra-Alert outputs of T1 and T2 = 0.08 +/- 0.08 percentage points). With exercise-clothing, the Hydra-Alert evidenced low-moderate correlations between percent nude weight loss and Hydra-Alert output at 20 min (r = 0.59-T1, p = 0.13; r = 0.12-T2, p = 0.78), at 40 min (r = 0.93-T1, p = 0.001; r = 0.63-T2, p = 0.10), and at approximately 2 % weight loss (r = 0.21-T1 and T2, p = 0.61 and 0.62, respectively). The correlation at 40 min during T1 fell during T2 suggesting the Hydra-Alert was inconsistent. When wearing a ballistic-vest, the Hydra-Alert had poor validity (T1: r = - 0.29 [p = 0.48] for weight loss vs. monitor; T2: r = 0.11 [p = 0.80]). At the higher levels of dehydration ( approximately 2 %), the Hydra-Alert error was so high as to render its readings of little value. In some cases, the Hydra-Alert could lead to a false level of security if dehydrated. Therefore, the Hydra-Alert is of little use for those who want to measure their fluid loss while exercising in the heat.
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Affiliation(s)
- J Wickwire
- Department of Health, Physical Education, and Sport Science, Kennesaw State University, Kennesaw, GA 30144-5591, USA.
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Schuler PB, Richardson MT, Ochoa P, Wang MQ. Accuracy and repeatability of the Yale physical activity survey in assessing physical activity of older adults. Percept Mot Skills 2001; 93:163-77. [PMID: 11693682 DOI: 10.2466/pms.2001.93.1.163] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The purpose of this study was to extend the initial evaluation of the Yale Physical Activity Survey to assess physical activity in older adults. The survey yields three indicators of physical activity reflecting activities performed during a typical week of the previous month (Total Time, Total Energy Expenditure) and the past month (Total Activity Summary Index). Questionnaire validity was studied in 56 men and women, ages 56 to 86 years, by comparing the average of 3- or 7 day 24-hr. physical activity records (n=56), predicted maximal oxygen consumption (VO2 max) (n = 23) and the sum of three skinfold measurements. Two-week repeatability was estimated by calculating an intraclass coefficient using an analysis of variance with repeated measures. Spearman rhos were used to study questionnaire validity. Analysis showed the survey was easily administered and scored and exhibited moderate-to-good repeatability. For the first administration the Total Energy Expenditure Index was significantly associated with the physical activity diary (r = .27). On the second administration, correlations were significant for the physical activity diary with the Total Energy Expenditure Index (r = .30), the Total Activity Summary Index (r = .36), and the Total Time Index (r = .27), and for VO2 max and the Total Time Index (r = .49) and Total Activity Summary Index (r = .64). Relative to the criterion measures used in this study, some validity was evident for the second administration in this relatively active and healthy sample of older adults.
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Affiliation(s)
- P B Schuler
- The University of West Florida, Department of Health, Leisure and Exercise Science, Pensacola 32514-5751, USA.
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Abstract
PURPOSE The ability of the Stanford 7-Day Recall (7-DR), a well known instrument for surveying work and leisure-time physical activity (PA) in epidemiologic studies, to assess levels of habitual PA in men and women was evaluated. METHODS The 7-DR was administered twice, one month apart. Its accuracy was studied in 77 men and women, aged 20-59 years, by its repeatability and comparison of both administrations of the 7-DR with: fourteen 48-hour physical activity records; fourteen 48-hour Caltrac accelerometer readings; peak oxygen uptake (VO(2) peak) determinations; and percent body fat. These criteria measures were obtained over a year's duration. RESULTS One month repeatability correlation coefficients for 7-DR total activity were r = 0.60 and r = 0.36 for men and women, respectively. Comparison of corresponding indices of activity between the 7-DR and the PA record indicated: 1) a closer relationship in men for total (r = 0.58 for visit 10 7-DR and 0.66 for visit 11 7-DR, p < or = 0.01), and very hard (r = 0.44 and 0.60, p< or = 0.05) activity then in women (r = 0.32 and 0.33, p < or = 0.05, and r = 0.21, ns and 0.43, p< or = 0.01, respectively); and 2) in general, lower and less consistent associations for hard, moderate, and light activity. Total PA by the 7-DR was significantly associated with Caltrac readings in men only. 7-DR results were more consistently related to VO(2) peak in men than women, but were significantly related to percent body fat in women only. CONCLUSIONS The ability of the 7-DR to assess habitual PA was greater for more vigorous than for lower intensity PA.
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Affiliation(s)
- M T Richardson
- University of Alabama, Human Performance, College of Education, Tuscaloosa, AL 35487-0312, USA
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Abstract
PURPOSE The Kaiser Physical Activity Survey (KPAS) was evaluated for test-retest reliability and comparison with direct and indirect measures of physical activity (PA) in 50 women (ages 20-60 yr) with a broad range of physical activity (PA) habits. METHODS The KPAS, an adaptation of the Baecke usual physical activity survey, was designed specifically to assess activity in women. It provides four summary activity indexes: housework/caregiving, active living habits, sports, and occupation. Summary indexes were compared against direct (Caltrac accelerometer and PA records) and indirect (cardiorespiratory fitness (VO2 peak) and percent body fat) criterion measures of PA. Participants kept detailed PA records for two, 7-d periods, separated by 1 month. Caltrac accelerometers were worn concurrently with the PA records. RESULTS Intraclass correlations for 1-month test-retest reliability were high for all KPAS indexes (r = 0.79 to 0.91, P < 0.01). Age-adjusted Spearman rho correlations between the KPAS sports/exercise and active living habits indexes were of moderate magnitude for VO2 peak (r = 0.34 to 0.76, P < 0.01) and percent body fat (r = -.30 to -0.59, P < 0.05). KPAS caregiving and occupation indexes were related to Caltrac kcal x d(-1) (r = 0.30 to 0.44, P < 0.05). Correlations between similar activities from the KPAS and PA records ranged from r = 0.03 to 0.64. Daily, habitual activities from the KPAS and PA records had the highest correlations (r > 0.28). Correlations among infrequent activities were lower (r < 0.05). CONCLUSION The KPAS demonstrated good reliability and was reasonably accurate in detecting regular housework/caregiving, occupation, sports/exercise, and active leisure activities among women with a broad range of physical activity habits.
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Affiliation(s)
- B E Ainsworth
- Department of Epidemiology and Biostatistics and School of Public Health, University of South Carolina, Columbia, USA.
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Abstract
PURPOSE The magnitude of intra-individual variation, as determined by three methods of physical activity (PA) assessment, was estimated to determine the optimal number of repeated measures needed to reliably measure an individual's usual PA habits. METHODS Data were obtained from 77 healthy adults enrolled in the Survey of Activity, Fitness, and Exercise (SAFE). PA was measured by: 1) Caltrac accelerometers worn 48-hours every 26 days for one year; 2) concurrent 48-hour PA records (PARs); and 3) a corresponding series of four-week PA histories (FWH). Repeated measures regression analyses were used to analyze the data. RESULTS PA tended to be slightly higher in the summer months as compared with the winter months, but this seasonality explained little of the intra-individual variation. The intra-individual standard deviation (SD) estimated for the FWH (180 MET-min(d(-1))) was 39% of the mean annual MET-min(d(-1)), as compared with the Caltrac (163 MET-mind(d(-1)) or 9%) and PAR (259 MET-min(d(-1)) or 11%). Given the intra-individual variation, three repeated observations of the FWH, six Caltrac, or nine PAR over the course of the year were needed to achieve 80% reliability in estimation of mean annual PA. CONCLUSIONS Intra-individual variation in PA is substantial and must be accounted for in estimates of usual PA.
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Affiliation(s)
- S Levin
- Department of Epidemiology and Biostatistics, School of Public Health, University of South Carolina, Columbia, USA
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Clapp LL, Richardson MT, Smith JF, Wang M, Clapp AJ, Pieroni RE. Acute effects of thirty minutes of light-intensity, intermittent exercise on patients with chronic fatigue syndrome. Phys Ther 1999; 79:749-56. [PMID: 10440661] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND AND PURPOSE Currently, there is no consensus on exercise prescription for patients with chronic fatigue syndrome (CFS). This investigation examined whether light-intensity, intermittent physical activity exacerbated symptoms in patients with CFS immediately following exercise to 7 days following exercise. Subjects. Subjects were 9 women (mean age=44.2 years, SD=8.4, range=29-56; mean weight=74.2 kg, SD=18.8, range=56.36-110.91; and mean height=1.63 m, SD=0.8, range=1.55-1.78) and 1 man (age=48 years, weight=97.1 kg, and height= 1.98 m) who met the Centels for Disease Control and Prevention's criteria fi)r (FS. METHODS Subjects performed 10 discontinuous 3-minute exercise bouts (separated by 3 minutes of recovery) at a self-selected, comfortable walking pace on a treadmill. Oxygen consumption, minute ventilation, respiratory exchange ratio, and heart rate were measured every minute during the exercise session. To assess degree of disability, general health status, activity level, symptoms, and mood, subjects completed various questionnaires before and after exercise. RESULTS Results indicated that degree of disability, general health status, symptoms, and mood did not change immediately and up to 7 days following exercise. CONCLUSION AND DISCUSSION Thirty minutes of intermittent walking did not exacerbate symptoms in subjects with CFS. The physiological data did not show any abnormal response to exercise. Although this study did not determine whether 30 minutes of continuous versus intermittent exercise would exacerbate symptoms, all 10 subjects felt that they could not exercise continuously for 30 minutes without experiencing symptom exacerbation. Despite this limitation, the results indicate that some individuals with CFS may be able to use low-level, intermittent exercise without exacerbating their symptoms.
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Affiliation(s)
- L L Clapp
- Health, Physical Education, and Recreation Department, Southwest Texas State University, San Marcos 78666, USA.
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Abstract
BACKGROUND 6-Methylsalicylic acid synthase (MSAS), a fungal polyketide synthase from Penicillium patulum, is perhaps the simplest polyketide synthase that embodies several hallmarks of this family of multifunctional enzymes--a large multidomain protein, a high degree of specificity toward acetyl-CoA and malonyl-CoA substrates, chain length control, and regiospecific ketoreduction. MSAS has recently been functionally expressed in Escherichia coli and Saccharomyces cerevisiae, leading to the engineered biosynthesis of 6-methylsalicylic acid in these hosts. These developments have set the stage for detailed mechanistic studies of this model system. RESULTS A three--step purification procedure was developed to obtain >95% pure MSAS from extracts of E. coli. As reported earlier for the enzyme isolated from P. patulum, the recombinant enzyme produced 6-methylsalicylic acid (a reduced tetraketide) in the presence of acetyl-CoA, malonyl-CoA, and NADPH, but triacetic acid lactone (an unreduced triketide) in the absence of NADPH. Consistent with this observation, point mutations in the highly conserved nucleotide-binding motif of the ketoreductase domain also led to production of triacetic acid lactone in vivo. The enzyme showed some tolerance toward nonnatural primer units including propionyl- and butyryl-CoA, but was incapable of incorporating extender units from (R, S)-methylmalonyl-CoA. Interestingly, MSAS readily accepted the N-acetylcysteamine (NAC) analog of malonyl-CoA as a substrate. CONCLUSIONS NAC thioesters are simple, cost-effective analogs of CoA thioester substrates, and therefore provide a facile strategy for probing the molecular recognition features of polyketide synthases using unnatural building blocks. The ability to produce 4-hydroxy-6-methyl-2-pyrone in both E. coli and yeast illustrates the feasibility of metabolic engineering of these hosts to produce unnatural polyketides. Finally, the abundant source of recombinant MSAS described here provides an opportunity to study this fascinating model system using a combination of structural, mechanistic, and mutagenesis approaches.
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Affiliation(s)
- M T Richardson
- MR Chemistry, NP Chemical Engineering, Stanford University, California 94305-5025, USA
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Abstract
The validity of the Tecumseh Occupational Activity Questionnaire (TOQ) and a modified Seven Day Recall (SDR) was measured in 46 healthy women, ages 20-60 years (mean +/- SD, 39.4 +/- 11.8). Occupational data were compared with direct (7-day occupational activity records and Caltrac accelerometer) and indirect (maximal oxygen uptake and percent body fat) measures of physical activity status. Physical activity survey and occupational record data were log transformed to normalize skewed distributions. Intraclass correlations ranged from r = 0.26 to 0.73 (P < 0.05) between similar activities on the TOQ and activity records for light intensity sitting, light-to-moderate intensity standing, and walking. Correlations between similar activities from the SDR and activity records ranged from r = 0.32 to 0.35 (P < 0.05) for light and moderate intensity activities. Correlations for total occupational activity between the surveys and activity records were r = 0.46 (P < 0.001) for the TOQ and r = 0.45 (P < 0.01) for the SDR. A modest correlation (r = 0.34, P < 0.10) was observed between the Caltrac scores and TOQ moderate intensity standing. Only the TOQ light-to-moderate intensity standing was related to maximal oxygen uptake (r = 0.32, P < 0.05). None of the measures were related to percent body fat (P > 0.05). These results suggest that the TOQ and SDR both provide reasonably accurate measurements of light and moderate intensity occupational physical activity.
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Affiliation(s)
- B E Ainsworth
- Department of Epidemiology and Biostatistics, School of Public Health, University of South Carolina, Columbia 29208, USA
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Ashley CD, Smith JF, Robinson JB, Richardson MT. Disordered eating in female collegiate athletes and collegiate females in an advanced program of study: a preliminary investigation. Int J Sport Nutr 1996; 6:391-401. [PMID: 8953341 DOI: 10.1123/ijsn.6.4.391] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The purpose of this study was to use the Eating Disorders Inventory-2 (EDI-2) to compare disordered eating pathology between female intercollegiate athletes and a control group of nonathletic subjects enrolled in an advanced program of study. Analysis of variance (ANOVA) procedures revealed no significant difference (NSD) (p > .05) between any of the athletic groups or the control group on any EDI-2 subscale, and there was no significant difference between "lean" sports, other sports, and the control group. There was also NSD on EDI-2 subscale scores on the basis of age. African Americans had significantly lower scores on the Body Dissatisfaction and Impulse Regulation subscales than white Americans. Chi-square analysis revealed NSD between any groups in percentage of respondents scoring above anorexic norms. The results did not indicate a greater amount of disordered eating in female athletes compared to nonathlete controls.
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Affiliation(s)
- C D Ashley
- School of Physical Education, Wellness, and Sport Studies, University of South Florida, Tampa 33620-8600, USA
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Richardson MT, Ainsworth BE, Wu HC, Jacobs DR, Leon AS. Ability of the Atherosclerosis Risk in Communities (ARIC)/Baecke Questionnaire to assess leisure-time physical activity. Int J Epidemiol 1995; 24:685-93. [PMID: 8550264 DOI: 10.1093/ije/24.4.685] [Citation(s) in RCA: 173] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND The Atherosclerosis Risk in Communities (ARIC)/Baecke Questionnaire is a general survey of both occupational and leisure (sport and exercise related and non-sport and exercise related) physical activity. METHODS Its ability to assess leisure physical activity was studied in 78 men and women, age 20-59 years, by comparison to: six 48-hour physical activity records; 14 48-hour Caltrac accelerometer readings (Caltrac); three peak oxygen consumption (VO2 peak) determinations; and per cent body fat. These criteria measures were obtained over a year's duration. RESULTS The following associations were evident in men and women respectively, between sport and exercise physical activity and: physical activity record heavy intensity activity (r = 0.73 and r = 0.63); VO2 peak (r = 0.67 and r = 0.45); and per cent body fat (r = -0.37, P = 0.08 and r = -0.44). Less concordance was evident (r = 0.39 for men and r = 0.23, NS, for women) between non-sport and exercise physical activity and physical activity record light intensity activity. Questionnaire and physical activity record indices of total leisure activity tended to be more closely related in men (r = 0.59) than women (r = 0.33). For both men and women, survey results were not closely associated with Caltrac readings. CONCLUSIONS Although there are weaknesses, questionnaire strengths consistent for both men and women include: ease of administration, high reliability, and accurate assessment of heavy intensity activity as well as light intensity activities such as walking and bicycling.
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Richardson MT, Leon AS, Jacobs DR, Ainsworth BE, Serfass R. Ability of the Caltrac accelerometer to assess daily physical activity levels. J Cardiopulm Rehabil 1995; 15:107-13. [PMID: 8542513 DOI: 10.1097/00008483-199503000-00003] [Citation(s) in RCA: 56] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
PURPOSE The purpose of this study was to determine the ability of the Caltrac accelerometer to assess habitual daily physical activity levels. METHODS The ability of the Caltrac accelerometer to assess 24-hour physical activity (PA) levels was studied in 28 men and 50 women, age 20 to 59 years, with varying levels of self-reported PA. Twelve days of Caltrac readings obtained over 1 year's duration were compared to simultaneously recorded 48-hour PA records. Additionally, 28 days of Caltrac readings obtained over 1 year's duration were compared to mean values of the following validation measures assessed repeatedly over a 1-year period: a 4-week version of the Minnesota Leisure Time Physical Activity Questionnaire (FWH); VO2peak; and percent body fat. RESULTS The Caltrac measurements of movement (in MET minutes per day-1) were significantly associated with the following: PA record indices of total (r = .51) and heavy (r = .34) and PA; FWH indices of total (r = .30), heavy R = .36) and moderate (r = .23) PA;, and VO2peak (r = .24). However, the Caltrac measurements of caloric PA record and FWH indices of PA, although there were directly associated with percent body fat (r = .50) and inversely associated with VO2peak (r = -.26). CONCLUSIONS Caltrac measurements of movement exhibited a moderate associated with several criterion measures related to habitual PA, whereas Caltrac measurements of total energy expenditure, were not reflective of varying levels of PA.
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Affiliation(s)
- M T Richardson
- Human Performance, University of Alabama, Tuscaloosa 35487-0312, USA
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Wang MQ, Nicholson ME, Richardson MT, Fitzhugh EC, Reneau P, Westerfield CR. The acute effect of moderate alcohol consumption on cardiovascular responses in women. J Stud Alcohol 1995; 56:16-20. [PMID: 7752627 DOI: 10.15288/jsa.1995.56.16] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE The purpose of this study was to assess the effects of moderate dose alcohol consumption on human metabolic and cardiovascular responses during submaximal exercise. METHOD Ten female subjects participated in two experimental conditions: (1) an alcohol session where the subjects ingested 0.625 g per kg body weight of 80-proof ethyl alcohol (0.25 g/kg of 100% ethanol), and (2) a placebo session. In each session, the subjects exercised on a stationary bicycle at 70% predicted maximum heart rate (HR) for 30 minutes. HR, blood pressure (BP) and oxygen consumption (VO2) were measured at the baseline and at 10, 20 and 30 minute intervals during exercise. Blood lactic acid (BLA) was measured at the baseline and at the end of exercise. RESULTS Repeated analysis of variance and subsequent comparisons showed that the alcohol session had significantly higher scores for HR, BP, VO2 and BLA than the placebo session (p < .05). CONCLUSIONS These results suggest that during submaximal work, acute moderate alcohol consumption may interfere with aerobic energy metabolism, thus increasing the demand placed upon the cardiovascular system.
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Affiliation(s)
- M Q Wang
- Health and Human Performance Studies, University of Alabama, Tuscaloosa 35487, USA
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Richardson MT, Holly RG, Amsterdam EA, Wang MQ. The value of ten common exercise tolerance test measures in predicting coronary disease in symptomatic females. Cardiology 1995; 86:243-8. [PMID: 7614498 DOI: 10.1159/000176882] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The diagnostic contribution of ten common exercise tolerance test (ETT) measures compared with coronary angiography was studied in 62 symptomatic females (mean age = 53 +/- 9 years). Logistic regression revealed that maximal ST-segment depression, the percent of predicted maximal heart rate achieved, and test chest pain all contributed unique predictive information and formed a model generating probabilities for coronary disease (CAD). Using a predicted probability for the presence of CAD of 0.50 as a cutpoint, test accuracy was markedly improved (sensitivity = 73%, specificity = 94%, and overall correct classification rate = 90%) over the standard ST response. We conclude that multivariate analysis using these three easily assessed ETT measures provides superior discrimination between symptomatic women with and without CAD when compared to changes in the ST-segment alone.
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Abstract
The accuracy of the Minnesota Leisure Time Physical Activity (LTPA) Questionnaire (a 1-year survey of non-occupational activity used in MRFIT) was studied in 78 men and women, age 20-59 years, by comparing survey results to the following measures obtained over a year's duration: six 48-hour physical activity records; fourteen 48-hour Caltrac accelerometer readings (Caltrac); 14 administrations of a 4-week version of the LTPA Questionnaire (FWH); 3 VO2peak determinations and percent body fat (% BF). The LTPA Questionnaire demonstrated: weak to moderate associations with % BF (r = -0.24) and with VO2peak (r = 0.47); a weak association with Caltrac readings expressed as MET.minutes.day-1 (r = 0.23); strong associations with corresponding activities reported on the FWH; and moderate associations with total and heavy activities reported in the physical activity record, but no associations with moderate and light activities. Furthermore, several types of LTPA were found to be either under-represented or not currently included in the Minnesota LTPA Questionnaire. It is concluded that although validation results were found to be quite good, several possible refinements were identified, which should improve the accuracy of the Minnesota LTPA Questionnaire in assessing habitual physical activity.
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Affiliation(s)
- M T Richardson
- Area of Health and Human Performance, University of Alabama, Tuscaloosa 35487-0312
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Abstract
The validity and reproducibility of the Physical Activity Index from the College Alumnus Questionnaire (PAI-CAQ) were determined in 78 men and women (21-59 yr) with a broad range of physical activity habits. The PAI-CAQ was computed as the sum of energy expended in stair climbing, walking, and sports and recreational physical activity recalled from the past week. Data were validated against measures of cardiorespiratory fitness, body fatness, motion detection, and physical activity records. All physical activity was recorded by participants for six 48-hour periods. Each day of the week, including weekends, were represented at least twice in the physical activity records. Age-adjusted correlation coefficients between like activities on the College Alumnus Questionnaire and physical activity records ranged from 0.25 to 0.65 in men and 0.28 to 0.86 in women. Correlations between the PAI-CAQ and validation criteria that reflected total and heavy-intensity physical activities were higher (r = 0.34-0.69, p < 0.05) than for lighter-intensity physical activities and motion detection expressed in MET-min.d-1 and kcal.d-1 (r < 0.35, p > 0.05). Test-retest reproducibility was higher over 1 month (r = 0.72) than over 8 and 9 months (r = 0.34 and 0.43) (p < 0.05). Energy expended in walking and stair climbing was underestimated on the College Alumnus Questionnaire, resulting in lower PAI-CAQ scores, as compared to the physical activity records.
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Affiliation(s)
- B E Ainsworth
- Department of Physical Education, Exercise and Sport Science, School of Public Health, University of North Carolina at Chapel Hill 27599
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Ainsworth BE, Jacobs DR, Leon AS, Richardson MT, Montoye HJ. Assessment of the accuracy of physical activity questionnaire occupational data. J Occup Med 1993; 35:1017-27. [PMID: 8271073] [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] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The validity and reliability of occupational physical activity data from survey instruments were determined in 75 men and women (age 23 to 59 years) in white-collar jobs. Data were validated against measures of cardiorespiratory fitness, body fatness, motion detection, pulmonary function, and 12 days of occupational physical activity records. More than 90% of occupational physical activity was spent in light-intensity sitting, standing, and walking. Test-retest reliability was high for most occupational questions (r > or = .63, P < .05). Correlation coefficients between questionnaire data and validation criteria that reflect heavy-intensity physical activity were low (r < .17, P > .05). The modified Tecumseh Occupational Questionnaire and Seven-Day Recall, which classified occupational physical activity in hours per week worked and average level of ratio of associated metabolic rate for a specific activity divided by the resting metabolic rate, on the job, correlated best with physical activity records (r = .11 to .47). Validation of these self-administered questionnaires in populations with a greater diversity of jobs and occupational energy requirements is needed.
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Affiliation(s)
- B E Ainsworth
- Department of Physical Education, Exercise, & Sport Science, School of Public Health, University of North Carolina, Chapel Hill 27599-8700
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Abstract
UNLABELLED The predictive power of 10 common exercise test parameters compared with coronary angiography was studied. Only the exercise electrocardiogram (EXECG), maximal rate pressure product (MAXRPP), and exercise chest pain (EXCP) contributed unique predictive information with the emergence of two interactions involving EXCP (EXCP.EXECG and EXCP.MAXRPP). IN CONCLUSION (1) EXCP appears to be a more serious finding only in those higher risk individuals with either a positive EXECG or lower MAXRPP; (2) EXCP and its interactions may help discriminate between anginal and nonanginal, exertional chest pain, and (3) the contradictory results found when EXCP was allowed to interact may explain conflicting results in previous multivariate models regarding the predictive significance of EXCP.
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Affiliation(s)
- M T Richardson
- Human Performance Laboratory, University of California Davis
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