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Babalola O, Gebben D, Tarver ME, Sangha R, Roberts J, Price V. Patient Preferences Regarding Surgical Treatment Methods for Symptomatic Uterine Fibroids. Ther Innov Regul Sci 2023:10.1007/s43441-023-00525-1. [PMID: 37210440 PMCID: PMC10400705 DOI: 10.1007/s43441-023-00525-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 04/14/2023] [Indexed: 05/22/2023]
Abstract
STUDY OBJECTIVE The purpose of this study is to rank the factors that are most and least important to patients with symptomatic uterine fibroids when considering surgical treatment options. MATERIALS AND METHODS Using a best worst scaling (BWS) preference elicitation approach, participants completed an online survey to rank factors associated with fibroid surgical treatments. Survey content was based on a literature review and included the following factors: symptom relief; surgical complications; repeat treatment; recovery time; cosmetic effects; risk of spreading undiagnosed cancer; sexual outcomes; maintenance of child-bearing; continuation of menses; unpredictable menses; and location of procedure. Participants completed 11 BWS tasks. For each task, we presented participants with a subset of 5 factors from the possible 11, and participants chose the most important and least important factor. Participants' responses were analyzed using conditional logistic regression to determine the relative importance of factors. Patient priorities were further explored via age and race. RESULTS 285 respondents with symptomatic uterine fibroids (69 physician-confirmed and 216 self-reported) who had not undergone prior surgical treatment completed the survey. Respondents were enrolled from two clinical sites (clinical site cohort) and an online consumer panel (panel cohort). Both cohorts identified symptom relief, cancer risk, repeat treatment and complications as the most important factors in selecting surgical treatment options and location of procedure, return to normal activities after surgery, and cosmetic effects like presence of a scar after the surgical treatment as the least important factors. Of note, younger women (≤ 40) placed greater importance on the ability to have children after the procedure. CONCLUSION Information regarding the factors most and least important to patients with symptomatic uterine fibroids might inform development and regulatory evaluation of new technologies and procedures. Study results may be useful in efforts to develop a set of outcomes to include in future fibroids clinical studies.
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Affiliation(s)
- Olufemi Babalola
- Patient Science & Engagement, Office of Strategic Partnerships and Technology Innovation, Center for Devices and Radiological Health, U.S. Food and Drug Administration, White Oak, Bldg. 66, Room 5574, Silver Spring, MD, 20993, USA.
| | - David Gebben
- Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - Michelle E Tarver
- Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - Roopina Sangha
- Department of Obstetrics and Gynecology, JPS Health Network, Fort Worth, TX, USA
| | - Jason Roberts
- Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - Veronica Price
- Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, MD, USA
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Allen A, Hoang C, Sangha R. COVID-19-Associated Coagulopathy in the Peripartum Setting: A Case Report. AJP Rep 2022; 12:e33-e35. [PMID: 35141033 PMCID: PMC8816627 DOI: 10.1055/s-0041-1742237] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 10/08/2021] [Indexed: 11/13/2022] Open
Abstract
Sepsis-induced coagulopathy (SIC) scoring and D-dimer can be used to recognize COVID-19-induced coagulopathy, but the utility of these is largely unknown in the peripartum setting and leaves anticoagulation guidance unclear. We present the case of a critically ill postpartum patient with COVID-19 infection. This patient presented with clinical signs of COVID-19 infection and developed acute respiratory failure requiring invasive mechanical ventilation and subsequent cesarean delivery at 34 weeks. She initially improved postoperatively but deteriorated after postoperative day 5. She was found to have a very elevated D-dimer of 58 μg/mL and anticoagulation was escalated to full dosing. She required prolonged mechanical ventilation and deceased after developing gram-positive cocci bacteremia. This case demonstrates that recognition and management of COVID-19-associated coagulopathy can be confusing in the peripartum period and studies are needed to validate D-dimer and SIC scoring in this population of patients.
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Affiliation(s)
- Ashley Allen
- Department of Obstetrics and Gynecology, John Peter Smith Hospital, Fort Worth, Texas
| | - Christine Hoang
- Department of Obstetrics and Gynecology, John Peter Smith Hospital, Fort Worth, Texas
| | - Roopina Sangha
- Department of Obstetrics and Gynecology, John Peter Smith Hospital, Fort Worth, Texas
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Babalola O, Sangha R, Roberts J, Price V. Patient Preferences Regarding Surgical Treatment Methods for Symptomatic Uterine Fibroids. J Minim Invasive Gynecol 2021. [DOI: 10.1016/j.jmig.2021.09.227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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4
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Anaka M, Gibson A, Dean M, Elegbede A, Petersen L, Tudor R, Sangha R, Bebb D. FP02.03 Changing Survival and Treatment Patterns in Patients Aged 80 or Older with Stage IV Non-Small Cell Lung Cancer (NSCLC). J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.075] [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: 12/01/2022]
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Smith N, Floyd M, Sangha R, Cheng P, Osborne A, Pitts DS, Bazan L. 102 The efficacy of a pilot program for obstructive sleep apnea screening in pregnancy. Am J Obstet Gynecol 2021. [DOI: 10.1016/j.ajog.2020.12.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Sangha R, Bossick A, Su WTK, Coleman C, Chavali N, Wegienka G. A Prospective Study of Patterns of Regret in the Year After Hysterectomy. J Patient Cent Res Rev 2020; 7:329-336. [PMID: 33163553 PMCID: PMC7644126] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023] Open
Abstract
PURPOSE This study sought to identify patterns of self-reported regret after hysterectomy. METHODS Women undergoing hysterectomy for a benign indication were recruited in the 2 weeks prior to surgery. Women reported demographics and completed validated questionnaires (Decisional Regret Scale, Patient Health Questionnaire-9, Decisional Conflict Scale, and the Comprehensive Score for Financial Toxicity) up to 7 times over the first year postsurgery. Medical records were reviewed for clinical and operative details. Latent class growth mixture models were applied to the repeated regret scores to identify patterns after hysterectomy. Clinical and other participant characteristics were compared across the classes. RESULTS Three latent classes were identified among the 459 participants (422 of whom completed questionnaires at 12 months): "High Regret" (7.4%), women with a high regret score at baseline that did not improve over time; "Decreasing Regret" (13.3%), women with high baseline levels of regret but whose regret scores improved over time; and "Least Regret" (79.3%), women with the lowest baseline regret scores that remained low after surgery. These classes did not vary with respect to indication for surgery, clinical characteristics, age, or body mass index. Disproportionately more African American women (adjusted odds ratio: 1.99, 95% CI: 1.01-3.9) were in the "Decreasing Regret" versus "Least Regret" classes. Baseline satisfaction varied between the classes, with the "Least Regret" group having higher baseline satisfaction with their decision. Women with "Decreasing Regret" reported worse financial toxicity associated with surgery versus women in the "Least Regret" class (adjusted odds ratio: 0.95, 95% CI: 0.92-0.99). CONCLUSIONS For some women, decisional regret may worsen after hysterectomy. More often, initial regret lessens over time. Future studies that identify factors strongly associated with self-reported regret could lead to improved counseling about postsurgical expectations.
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Affiliation(s)
- Roopina Sangha
- Department of Women’s Health Services, Henry Ford Health System, Detroit, MI
| | - Andrew Bossick
- Department of Public Health Sciences, Henry Ford Health System, Detroit, MI
- Center of Innovation for Veteran-Centered and Value-Driven Care, U.S. Department of Veterans Affairs (VA) Health Services Research and Development, VA Puget Sound Healthcare System, Seattle, WA
- Department of Health Services, School of Public Health, University of Washington, Seattle, WA
| | - Wan-Ting K. Su
- Department of Public Health Sciences, Henry Ford Health System, Detroit, MI
| | - Chad Coleman
- Department of Public Health Sciences, Henry Ford Health System, Detroit, MI
| | - Neha Chavali
- Department of Women’s Health Services, Henry Ford Health System, Detroit, MI
| | - Ganesa Wegienka
- Department of Public Health Sciences, Henry Ford Health System, Detroit, MI
- inVivo Planetary Health, Worldwide Universities Network, West New York, NJ
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Sangha R, Bossick A, Su WTK, Coleman C, Chavali N, Wegienka G. A Prospective Study of Patterns of Regret in the Year After Hysterectomy. J Patient Cent Res Rev 2020. [DOI: 10.17294/2330-0698.1759] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Kalmbach DA, Cuamatzi-Castelan A, Tonnu CV, Roth T, Sangha R, Swanson LM, O’Brien LM, Drake CL. 0470 A Randomized Controlled Trial of Digital Cognitive Behavioral Therapy for Insomnia in Pregnant Women. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Over half of pregnant women experience clinical insomnia, which is linked to perinatal depression and cognitive-emotional dysregulation. Despite high rates of prenatal insomnia and known maternal consequences, efficacious insomnia treatment options for this population are woefully scant. Early evidence from randomized controlled trials (RCTs) support the efficacy of face-to-face cognitive-behavioral therapy for insomnia (CBTI) for prenatal insomnia. Yet, as many patients are unable to access this specialist-driven care, a critical need exists to increase its accessibility. This RCT examined the efficacy digital CBTI via mobile health app in pregnant women with insomnia.
Methods
Single-site RCT. Ninety-one pregnant women (29.03±4.16 years) nearing/entering the third trimester who screened positive for clinical insomnia on the Insomnia Severity Index (ISI) were randomized to digital CBTI or digital sleep education control. Blinded assessments were performed before treatment, after treatment (during pregnancy), and 6 weeks after childbirth. The ISI, Pittsburgh Sleep Quality Index (PSQI), Edinburgh Postnatal Depression Scale (EPDS), and Pre-Sleep Arousal Scale’s Cognitive factor (PSAS-C) served as study outcomes.
Results
From pre to posttreatment, CBTI patients reported reductions in ISI (-4.91 points, p<.001) and PSQI (-2.98 points, p<.001) and increases in nightly sleep duration by 32 minutes. Sleep symptoms did not change during pregnancy in the control group. After childbirth, CBTI patients, relative to controls, slept longer by 40 minutes per night (p=.01) and reported better sleep maintenance. No pre or postnatal treatment effects on depression or cognitive arousal were observed.
Conclusion
Digital CBTI improves sleep quality and increases sleep duration during pregnancy and after childbirth. Digitally delivered interventions have potential to improve the health of new and expectant mothers, but CBTI likely needs to be tailored for perinatal patients to optimize outcomes.
Support
This study was funded by the American Academy of Sleep Medicine (198-FP-18, PI: Kalmbach).
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Affiliation(s)
| | | | | | - T Roth
- Henry Ford Health System, Detroit, MI
| | - R Sangha
- Henry Ford Health System, Detroit, MI
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Kalmbach DA, Cheng P, O'Brien LM, Swanson LM, Sangha R, Sen S, Guille C, Cuamatzi-Castelan A, Henry AL, Roth T, Drake CL. A randomized controlled trial of digital cognitive behavioral therapy for insomnia in pregnant women. Sleep Med 2020; 72:82-92. [PMID: 32559716 DOI: 10.1016/j.sleep.2020.03.016] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [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: 01/13/2020] [Revised: 02/18/2020] [Accepted: 03/12/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Despite high rates of prenatal insomnia, efficacious treatment options for this population are quite limited. Early evidence from randomized controlled trials (RCTs) support the efficacy of face-to-face cognitive-behavioral therapy for insomnia (CBTI) for prenatal insomnia. Yet, as many patients are unable to access this specialist-driven care, a critical need exists to increase its accessibility. This RCT examined the efficacy internet-based digital CBTI in pregnant women with insomnia. METHODS Single-site RCT. A total of 91 pregnant women (29.03 ± 4.16 years) nearing/entering the third trimester who screened positive for clinical insomnia on the Insomnia Severity Index (ISI) were randomized to digital CBTI or digital sleep education control. The ISI, Pittsburgh Sleep Quality Index (PSQI), Edinburgh Postnatal Depression Scale (EPDS), and Pre-Sleep Arousal Scale's Cognitive factor (PSAS-C) served as study outcomes, which were collected before treatment and after treatment during pregnancy, then six weeks after childbirth. RESULTS From pre to posttreatment, CBTI patients reported reductions in ISI (-4.91 points, p < 0.001) and PSQI (-2.98 points, p < 0.001) and increases in nightly sleep duration by 32 min (p = 0.008). Sleep symptoms did not change during pregnancy in the control group. After childbirth, CBTI patients, relative to controls, slept longer by 40 min per night (p = 0.01) and reported better sleep maintenance. No pre or postnatal treatment effects on depression or cognitive arousal were observed. CONCLUSIONS Digital CBTI improves sleep quality and sleep duration during pregnancy and after childbirth. To better optimize outcomes, CBTI should be tailored to meet the changing needs of women as the progress through pregnancy and early parenting. NAME: Insomnia and Rumination in Late Pregnancy and the Risk for Postpartum Depression. URL: clinicaltrials.gov. Registration: NCT03596879.
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Affiliation(s)
- David A Kalmbach
- Thomas Roth Sleep Disorders & Research Center, Henry Ford Health System, Detroit, MI, USA.
| | - Philip Cheng
- Thomas Roth Sleep Disorders & Research Center, Henry Ford Health System, Detroit, MI, USA
| | - Louise M O'Brien
- Departments of Obstetrics & Gynecology and Neurology, University of Michigan, Ann Arbor, MI, USA
| | - Leslie M Swanson
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Roopina Sangha
- Department of Obstetrics & Gynecology, Henry Ford Health System, Detroit, MI, USA
| | - Srijan Sen
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Constance Guille
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | | | - Alasdair L Henry
- Big Health Inc, San Francisco, CA, USA; Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Thomas Roth
- Thomas Roth Sleep Disorders & Research Center, Henry Ford Health System, Detroit, MI, USA
| | - Christopher L Drake
- Thomas Roth Sleep Disorders & Research Center, Henry Ford Health System, Detroit, MI, USA
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Kalmbach DA, Cheng P, Sangha R, O’Brien LM, Swanson LM, Palagini L, Bazan LF, Roth T, Drake CL. Insomnia, Short Sleep, And Snoring In Mid-To-Late Pregnancy: Disparities Related To Poverty, Race, And Obesity. Nat Sci Sleep 2019; 11:301-315. [PMID: 31807103 PMCID: PMC6839586 DOI: 10.2147/nss.s226291] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 10/05/2019] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE To characterize sleep habits and parameters among women in mid-to-late pregnancy and to identify disparities associated with poverty, race, and obesity. DESIGN Cross-sectional. SETTING Large multi-site health system in Metro Detroit. PARTICIPANTS A total of 267 pregnant women (27.3% non-Hispanic black; gestational age: 27.99±1.20 weeks) completed online surveys on sleep quality, insomnia symptoms, sleep aid use, signs/symptoms of sleep-disordered breathing, and sociodemographics. Body mass index (BMI) and patient insurance were derived from medical records. RESULTS As high as 76.2% of the women reported global sleep disturbance, 30.6% endorsed snoring, 24.3% sleep <6 hrs/night, and over half screened positive for clinical insomnia. Yet, only 3.4% of the women reported an insomnia diagnosis and 3.0% reported a sleep apnea diagnosis. In unadjusted models, poverty, Medicaid coverage, self-identifying as black, and obesity before and during pregnancy (BMI ≥ 35) were associated with a wide range of sleep problems. However, adjusted models revealed specificity. Poverty was uniquely related to increased insomnia symptoms and trouble sleeping due to bad dreams. Obesity before pregnancy was related to poor sleep quality, snoring, sleep aids, and short sleep. Black women reported shorter sleep duration than white women but differed on no other sleep parameters. CONCLUSION Clinical signs of insomnia and sleep-disordered breathing are common in mid-to-late pregnancy, but most cases go undetected. Problematic sleep disproportionately affects women in poverty, who self-identify as black, and who are obese before pregnancy. Poverty-related sleep issues are linked to insomnia, obesity-related disparities center on sleep-related breathing and medication use, and racial disparities relate to short sleep.
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Affiliation(s)
- David A Kalmbach
- Thomas Roth Sleep Disorders and Research Center, Henry Ford Health System, Novi, MI, USA
| | - Philip Cheng
- Thomas Roth Sleep Disorders and Research Center, Henry Ford Health System, Novi, MI, USA
| | - Roopina Sangha
- Department of Obstetrics and Gynecology, Henry Ford Health System, Detroit, MI, USA
| | - Louise M O’Brien
- Departments of Obstetrics &Gynecology and Neurology, University of Michigan, Ann Arbor, MI, USA
| | - Leslie M Swanson
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Laura Palagini
- Departments of Neuroscience and Psychiatry, University of Pisa, Pisa, Italy
| | - Luisa F Bazan
- Division of Sleep Medicine, Henry Ford Health System, Detroit, MI, USA
| | - Thomas Roth
- Thomas Roth Sleep Disorders and Research Center, Henry Ford Health System, Novi, MI, USA
| | - Christopher L Drake
- Thomas Roth Sleep Disorders and Research Center, Henry Ford Health System, Novi, MI, USA
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Sangha R, Bossick A, Coleman C, Su WT, Wegienka G. Description of Patterns and Exploration of Risk Factors for Regret One Year After Hysterectomy: A Longitudinal Prospective Study. J Minim Invasive Gynecol 2019. [DOI: 10.1016/j.jmig.2019.09.669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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12
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Cheema P, Evans W, Burkes R, Sangha R, Ho C, Wheatley-Price P, Boehm D, Venkatesh J, Walisser S, Grima D, Moldaver D, Hurry M. Estimating the cost and survival impact of new aNSCLC therapies in Canada with the iTEN model. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz260.104] [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: 11/14/2022] Open
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Abstract
Purpose Previous reports indicate many women may not have a firm grasp on likely outcomes of different hysterectomy procedures. This study aimed to assess women's self-reported expectations of how they think their anatomy will change after hysterectomy. Methods Women scheduled for hysterectomy at a tertiary care hospital, for non-oncological reasons, reported their planned procedure type and the organs they understood would be removed 2 weeks prior to surgery. Patient reports and electronic medical records were reviewed, and kappa statistics (κ) were calculated to assess agreement for all women and within subgroups. Results Most of the 456 study participants (mean age: 48.02 ± 8.29 years) were either white/Caucasian (n=238, 52.2%) or African American (n=196, 43.0%). Among the 145 participants who reported a partial hysterectomy, 130 (89.7%) women indicated that their uterus would be removed and 52 (35.9%) reported that their cervix would be removed. Of those whose response was total hysterectomy (n=228), 208 (91.2%) participants reported their uterus would be removed and 143 (62.7%) reported their cervix would be removed. Among 144 women reporting a planned partial hysterectomy, only 15 (10.4%, κ=0.05) had a partial hysterectomy recorded in the electronic medical record. Among the 228 women who reported a planned total hysterectomy, 6.1% (κ=0.05) had a different procedure. While 125 participants reported planned ovary removal, only 93 (74.4%, κ=0.55) had an oophorectomy. Similarly, 290 participants reported planned fallopian tube removal, with 276 (95.2%, κ=0.06) having a salpingectomy. Conclusions A considerable proportion of women undergoing hysterectomy do not accurately report the organs that are planned be removed during their hysterectomy. This work demonstrates the need to improve patient understanding of their clinical care and its implications.
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Affiliation(s)
- Zeinab Kassem
- Department of Public Health Sciences, Henry Ford Health System, Detroit, MI
| | - Chad M Coleman
- Department of Public Health Sciences, Henry Ford Health System, Detroit, MI
| | - Andrew S Bossick
- Department of Public Health Sciences, Henry Ford Health System, Detroit, MI
| | - Wan-Ting Su
- Department of Public Health Sciences, Henry Ford Health System, Detroit, MI
| | - Roopina Sangha
- Department of Obstetrics and Gynecology, Henry Ford Hospital, Detroit, MI
| | - Ganesa Wegienka
- Department of Public Health Sciences, Henry Ford Health System, Detroit, MI
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Skrabek P, Assouline S, Christofides A, MacDonald D, Prica A, Sangha R, Matthews BA, Sehn LH. Emerging therapies for the treatment of relapsed or refractory diffuse large B cell lymphoma. Curr Oncol 2019; 26:253-265. [PMID: 31548805 PMCID: PMC6726277 DOI: 10.3747/co.26.5421] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [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] [Indexed: 12/31/2022] Open
Abstract
Diffuse large B cell lymphoma (dlbcl) is an aggressive non-Hodgkin lymphoma, accounting for approximately 30% of lymphoma cases in Canada. Although most patients will achieve a cure, up to 40% will experience refractory disease after initial treatment, or relapse after a period of remission. In eligible patients, salvage therapy followed by high-dose therapy and autologous stem-cell transplantation (asct) is the standard of care. However, many patients are transplant-ineligible, and more than half of those undergoing asct will subsequently relapse. For those patients, outcomes are dismal, and novel treatment approaches are a critical unmet need. In this paper, we present available data about emerging treatment approaches in the latter setting and provide a perspective about the potential use of those approaches in Canada.
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Affiliation(s)
- P Skrabek
- Department of Hematology and Medical Oncology, University of Manitoba, and CancerCare Manitoba, Winnipeg, MB
| | - S Assouline
- Department of Medicine, Division of Hematology, Sir Mortimer B. Davis Jewish General Hospital and McGill University, Montreal, QC
| | | | | | - A Prica
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, and University of Toronto, Toronto, ON
| | - R Sangha
- University of Alberta and Cross Cancer Institute, Edmonton, AB
| | | | - L H Sehn
- Division of Medical Oncology, University of British Columbia, and BC Cancer, Vancouver, BC
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Kalmbach DA, Cheng P, Ong JC, Ciesla JA, Kingsberg SA, Sangha R, Swanson LM, O'Brien LM, Roth T, Drake CL. Depression and suicidal ideation in pregnancy: exploring relationships with insomnia, short sleep, and nocturnal rumination. Sleep Med 2019; 65:62-73. [PMID: 31710876 DOI: 10.1016/j.sleep.2019.07.010] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [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: 05/22/2019] [Revised: 07/03/2019] [Accepted: 07/09/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Sleep problems and depression are highly prevalent in pregnancy. Nocturnal rumination has been linked to insomnia and depression in non-pregnant samples, but remains poorly characterized in pregnancy. This study explored relationships of depression and suicidal ideation with insomnia, short sleep, and nocturnal rumination in mid-to-late pregnancy. METHODS In this study, 267 pregnant women were recruited from obstetric clinics and completed online surveys on sleep, depression, and nocturnal rumination. RESULTS Over half (58.4%) of the sample reported clinical insomnia on the Insomnia Severity Index, 16.1% screened positive for major depression on the Edinburgh Postnatal Depression Scale (EPDS), and 10.1% endorsed suicidal ideation. Nocturnal rumination was more robustly associated with sleep onset difficulties than with sleep maintenance issues. Depressed women were at greater odds of sleep onset insomnia (OR = 2.80), sleep maintenance insomnia (OR = 6.50), high nocturnal rumination (OR = 6.50), and negative perinatal-focused rumination (OR = 2.70). Suicidal ideation was associated with depression (OR = 3.64) and negative perinatal-focused rumination (OR = 3.50). A four-group comparison based on insomnia status and high/low rumination revealed that pregnant women with insomnia and high rumination endorsed higher rates of depression (35.6%) and suicidal ideation (17.3%) than good-sleeping women with low rumination (1.2% depressed, 4.9% suicidal). Women with insomnia alone (depression: 3.9%, suicidal: 5.9%) or high rumination alone (depression: 10.7%, suicidal: 7.1%) did not differ from good-sleeping women with low rumination. CONCLUSIONS High rumination and insomnia are highly common in mid-to-late pregnancy and both are associated with depression and suicidal ideation. Depression and suicidal ideation are most prevalent in pregnant women with both insomnia and high rumination. CLINICALTRIALS. GOV IDENTIFIER NCT03596879.
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Affiliation(s)
- David A Kalmbach
- Thomas Roth Sleep Disorders & Research Center, Division of Sleep Medicine, Henry Ford Health System, Detroit, MI, 48202, USA.
| | - Philip Cheng
- Thomas Roth Sleep Disorders & Research Center, Division of Sleep Medicine, Henry Ford Health System, Detroit, MI, 48202, USA
| | - Jason C Ong
- Departments of Neurology and Psychiatry & Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
| | - Jeffrey A Ciesla
- Department of Psychological Sciences, Kent State University, Kent, OH, 44240, USA
| | - Sheryl A Kingsberg
- Departments of Reproductive Biology and Psychiatry, Case Western Reserve University, Cleveland, OH, 44106, USA
| | - Roopina Sangha
- Department of Obstetrics & Gynecology, Henry Ford Health System, Detroit, MI, 48202, USA
| | - Leslie M Swanson
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Louise M O'Brien
- Departments of Obstetrics & Gynecology and Neurology, Ann Arbor, MI, 48105, USA
| | - Thomas Roth
- Thomas Roth Sleep Disorders & Research Center, Division of Sleep Medicine, Henry Ford Health System, Detroit, MI, 48202, USA
| | - Christopher L Drake
- Thomas Roth Sleep Disorders & Research Center, Division of Sleep Medicine, Henry Ford Health System, Detroit, MI, 48202, USA
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Kalmbach DA, Cuamatzi-Castelan AS, Tonnu CV, Sangha R, O’Brien LM, Swanson LM, Roth T, Drake CL. 0337 Insomniacs in Late Pregnancy are Clinically Depressed: Exploring the Role of Nocturnal Rumination. Sleep 2019. [DOI: 10.1093/sleep/zsz067.336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | | | | | - Louise M O’Brien
- University of Michigan- Deparment of Neurology, Ann Arbor, MI, USA
| | - Leslie M Swanson
- University of Michigan- Department of Psychiatry, Ann Arbor, MI, USA
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Cuamatzi-Castelan AS, Kalmbach DA, Atkinson R, Sangha R, Bazan L, O’Brien LM, Swanson LM, Roth T, Drake CL. 0338 Insomnia in Late Pregnancy: Characterizing Phenotypes and Identifying Associated Factors. Sleep 2019. [DOI: 10.1093/sleep/zsz067.337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | | | | | | | - Louise M O’Brien
- University of Michigan- Deparment of Neurology, Ann Arbor, MI, USA
| | - Leslie M Swanson
- University of Michigan- Department of Psychiatry, Ann Arbor, MI, USA
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Higenell V, Fajzel R, Batist G, Cheema PK, McArthur HL, Melosky B, Morris D, Petrella TM, Sangha R, Savard MF, Sridhar SS, Stagg J, Stewart DJ, Verma S. A network approach to developing immuno-oncology combinations in Canada. Curr Oncol 2019; 26:73-79. [PMID: 31043804 PMCID: PMC6476440 DOI: 10.3747/co.26.4393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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] [Indexed: 11/15/2022] Open
Abstract
Immune checkpoint inhibitors have revolutionized care for many cancer indications, with considerable effort now being focused on increasing the rate, depth, and duration of patient response. One strategy is to combine immune strategies (for example, ctla-4 and PD-1/L1-directed agents) to harness additive or synergistic efficacy while minimizing toxicity. Despite encouraging results with such combinations in multiple tumour types, numerous clinical challenges remain, including a lack of biomarkers that reliably predict outcome, the emergence of therapeutic resistance, and optimal management of immune-related toxicities. Furthermore, the selection of ideal combinations from the myriad of immune, systemic, and locoregional therapies has yet to be determined. A longitudinal network-based approach could offer advantages in addressing those critical questions, including long-term follow-up of patients beyond individual trials. The molecular cancer registry Personalize My Treatment, managed by the Networks of Centres of Excellence nonprofit organization Exactis Innovation, is uniquely positioned to accelerate Canadian immuno-oncology (io) research efforts throughout its national network of cancer sites. To gain deeper insight into how a pan-Canadian network could advance research in io combinations, Exactis invited preeminent clinical and scientific advisors from across Canada to a roundtable event in November 2017. The present white paper captures the expert advice provided: leverage longitudinal patient data collection; facilitate network collaboration and assay harmonization; synergize with existing initiatives, networks, and biobanks; and develop an io combination trial based on Canadian discoveries.
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Affiliation(s)
- V Higenell
- Exactis Innovation, Sir Mortimer B. Davis Jewish General Hospital, Montreal, QC
| | - R Fajzel
- Exactis Innovation, Sir Mortimer B. Davis Jewish General Hospital, Montreal, QC
| | - G Batist
- Exactis Innovation, Sir Mortimer B. Davis Jewish General Hospital, Montreal, QC
- Segal Cancer Centre, Sir Mortimer B. Davis Jewish General Hospital, Montreal, QC
| | - P K Cheema
- William Osler Health System, University of Toronto, Toronto, ON
| | - H L McArthur
- Division of Hematology Oncology, Cedars-Sinai Samuel Oschin Comprehensive Cancer Institute, Los Angeles, CA, U.S.A
| | - B Melosky
- Medical Oncology, BC Cancer-Vancouver Centre, Vancouver, BC
| | - D Morris
- Department of Oncology, Tom Baker Cancer Centre, Calgary, AB
| | - T M Petrella
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON
| | - R Sangha
- Department of Oncology, Cross Cancer Institute, Edmonton, AB
| | - M F Savard
- Department of Oncology, Tom Baker Cancer Centre, Calgary, AB
| | - S S Sridhar
- Medical Oncology, Princess Margaret Cancer Centre, Toronto, ON
| | - J Stagg
- Faculty of Pharmacy, University of Montreal, Montreal, QC
| | - D J Stewart
- Division of Medical Oncology, The Ottawa Hospital, Ottawa, ON
| | - S Verma
- Department of Oncology, Tom Baker Cancer Centre, Calgary, AB
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Brahmer J, Schenker M, Lee K, Provencio M, Nishio M, Lesniewski-Kmak K, Sangha R, Ahmed S, Raimbourg J, Feeney K, Corre R, Franke F, Richardet E, Penrod J, Yuan Y, Nathan F, Bhagavatheeswaran P, De Rosa M, Taylor F, Lawrance R, Reck M. OA05.06 CheckMate 227: Patient-Reported Outcomes of First-Line Nivolumab + Ipilimumab in High Tumor Mutational Burden Advanced NSCLC. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.261] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Melosky B, Cheema P, Agulnik J, Albadine R, Bebb DG, Blais N, Burkes R, Butts C, Card PB, Chan AMY, Hirsh V, Ionescu DN, Juergens R, Morzycki W, Poonja Z, Sangha R, Tehfe M, Tsao MS, Vincent M, Xu Z, Liu G. Canadian perspectives: update on inhibition of ALK-positive tumours in advanced non-small-cell lung cancer. Curr Oncol 2018; 25:317-328. [PMID: 30464681 PMCID: PMC6209554 DOI: 10.3747/co.25.4379] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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] [Indexed: 12/12/2022] Open
Abstract
Background Inhibition of the anaplastic lymphoma kinase (alk) oncogenic driver in advanced non-small-cell lung carcinoma (nsclc) improves survival. In 2015, Canadian thoracic oncology specialists published a consensus guideline about the identification and treatment of ALK-positive patients, recommending use of the alk inhibitor crizotinib in the first line. New scientific literature warrants a consensus update. Methods Clinical trials of alk inhibitor were reviewed to assess benefits, risks, and implications relative to current Canadian guidance in patients with ALK-positive nsclc. Results Randomized phase iii trials have demonstrated clinical benefit for single-agent alectinib and ceritinib used in treatment-naïve patients and as second-line therapy after crizotinib. Phase ii trials have demonstrated activity for single-agent brigatinib and lorlatinib in further lines of therapy. Improved responses in brain metastases were observed for all second- and next/third-generation alk tyrosine kinase inhibitors in patients progressing on crizotinib. Canadian recommendations are therefore revised as follows:■ Patients with advanced nonsquamous nsclc have to be tested for the presence of an ALK rearrangement.■ Treatment-naïve patients with ALK-positive disease should initially be offered single-agent alectinib or ceritinib, or both sequentially.■ Crizotinib-refractory patients should be treated with single-agent alectinib or ceritinib, or both sequentially.■ Further treatments could include single-agent brigatinib or lorlatinib, or both sequentially.■ Patients progressing on alk tyrosine kinase inhibitors should be considered for pemetrexed-based chemotherapy.■ Other systemic therapies should be exhausted before immunotherapy is considered. Summary Multiple lines of alk inhibition are now recommended for patients with advanced nsclc with an ALK rearrangement.
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Affiliation(s)
- B Melosky
- BC Cancer-Vancouver Centre, Vancouver, BC
| | - P Cheema
- William Osler Health System, University of Toronto, Brampton, ON
| | - J Agulnik
- Sir Mortimer B. Davis Jewish General Hospital, McGill University, Montreal, QC
| | - R Albadine
- Centre hospitalier de l'Université de Montréal, Montreal, QC
| | - D G Bebb
- Tom Baker Cancer Centre and University of Calgary, Calgary, AB
| | - N Blais
- Centre hospitalier de l'Université de Montréal, Montreal, QC
| | - R Burkes
- Mount Sinai Hospital, Toronto, ON
| | - C Butts
- Cross Cancer Institute and University of Alberta, Edmonton, AB
| | - P B Card
- Kaleidoscope Strategic, Inc., Toronto, ON
| | - A M Y Chan
- Tom Baker Cancer Centre and University of Calgary, Calgary, AB
| | - V Hirsh
- Royal Victoria Hospital, McGill University Health Centre, Montreal, QC
| | | | - R Juergens
- Juravinski Cancer Centre, McMaster University, Hamilton, ON
| | - W Morzycki
- qeii Health Sciences Centre, Halifax, NS
| | - Z Poonja
- BC Cancer-Vancouver Island Center, Victoria, BC
| | - R Sangha
- Cross Cancer Institute and University of Alberta, Edmonton, AB
| | - M Tehfe
- Centre hospitalier de l'Université de Montréal, Montreal, QC
| | - M S Tsao
- University Health Network, Princess Margaret Cancer Centre, Toronto, ON
| | - M Vincent
- University of Western Ontario, London, ON
| | - Z Xu
- qeii Health Sciences Centre, Halifax, NS
| | - G Liu
- University Health Network, Princess Margaret Cancer Centre, Toronto, ON
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Moldaver D, Hurry M, Tran D, Evans W, Cheema P, Sangha R, Burkes R, Melosky B, Orava E, Grima D. P2.15-09 The Impact of Treatment Evolution in NSCLC (iTEN) Model: Survival and Cost of Treating Patients with Advanced NSCLC in 2017. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.1450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Moldaver D, Hurry M, Tran D, Evans W, Cheema P, Sangha R, Burkes R, Melosky B, Orava E, Grima D. MA18.02 The Impact of Treatment Evolution in NSCLC (iTEN) Model: Development and Validation. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.466] [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: 11/27/2022]
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23
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Ondhia U, Conter H, Owen S, Zhou A, Nam J, Singh S, Abdulla A, Chu P, Felizzi F, Sangha R. P3.04-17 Cost-Effectiveness of Atezolizumab for Previously Treated Advanced or Metastatic Non-Small Cell Lung Cancer (NSCLC) in Canada. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.1724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Petersen SS, Doe S, Rubinfeld I, Davydova Y, Buekers T, Sangha R. Rate of Urologic Injury with Robotic Hysterectomy. J Minim Invasive Gynecol 2018; 25:867-871. [DOI: 10.1016/j.jmig.2018.01.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 01/03/2018] [Accepted: 01/06/2018] [Indexed: 11/17/2022]
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Bossick AS, Sangha R, Olden H, Alexander GL, Wegienka G. Identifying What Matters to Hysterectomy Patients: Postsurgery Perceptions, Beliefs, and Experiences. J Patient Cent Res Rev 2018; 5:167-175. [PMID: 29774227 DOI: 10.17294/2330-0698.1581] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose Hysterectomy is the most common non-obstetrical surgery for women in the United States. Few investigations comparing hysterectomy surgical approaches include patient-centered outcomes. Methods The study was performed at Henry Ford Health System in Detroit, Michigan between February 2015 and May 2015. The data were collected through structured focus groups with 24 post-hysterectomy women in order to identify PCOs to employ in a subsequent cohort study of hysterectomy surgical approaches. One pilot focus group and five additional focus groups were held. Qualitative data analysis, using data from coded transcripts of focus groups, was used to identify themes.Eligible women, aged between 18 and 65 years and had an EMR documented Current Procedural Terminology (CPT™) code or an International Statistical Classification of Diseases and Related Health Problems - Ninth Edition (ICD-9) code of hysterectomy between December 2012 and December 2014 (N=1,381, N=307 after exclusions) were selected and recruited. A question guide was developed to investigate women's experiences and feelings about the experience prior and subsequent to their hysterectomy. Analysis utilized the Framework Method. Results Focus groups with women who previously had a hysterectomy revealed their pre- and post-hysterectomy perceptions. Responses grouped into topics of pre- and post-surgical experiences, and information all women should know. Responses grouped into themes of 1) decision making, 2) the procedure - surgical experience, 3) recovery, 4) advice to past self, and 5) recommendations to other women. Conclusion These findings about perceptions, beliefs, and attitudes of women having undergone hysterectomy could support health care providers deliver patient-centered care. These results informed data collection for a prospective longitudinal cohort study that is now underway. The data suggest a need for increased education and empowerment in the decision making process, while expanding on information given for post-operative expectations and somatic changes that occur post-hysterectomy.
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Affiliation(s)
- Andrew S Bossick
- Department of Public Health Sciences, Patient-Engaged Research Center, Henry Ford Health System, Detroit, MI 48202, USA
| | - Roopina Sangha
- Department of Public Health Sciences, Patient-Engaged Research Center, Henry Ford Health System, Detroit, MI 48202, USA.,Obstetrics and Gynecology, Henry Ford Health System, Detroit, MI 48202, USA
| | - Heather Olden
- Department of Public Health Sciences, Patient-Engaged Research Center, Henry Ford Health System, Detroit, MI 48202, USA
| | - Gwen L Alexander
- Department of Public Health Sciences, Patient-Engaged Research Center, Henry Ford Health System, Detroit, MI 48202, USA
| | - Ganesa Wegienka
- Department of Public Health Sciences, Patient-Engaged Research Center, Henry Ford Health System, Detroit, MI 48202, USA
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Mok T, Peters S, Camidge DR, Gadgeel S, Ou S, Kim D, Dziadziuszko R, De Marinis F, Sangha R, Zeaiter A, Noe J, Nueesch E, Liu T, Loftin I, Williams C, Shaw A. JCES 01.27 Patients with ALK IHC-Positive/FISH-Negative NSCLC Benefit from ALK TKI Treatment: Response Data from the Global ALEX Trial. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.314] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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27
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Bossick A, Wegienka G, Sangha R. Association between Patient Depression Level and Hysterectomy Satisfaction. J Minim Invasive Gynecol 2017. [DOI: 10.1016/j.jmig.2017.08.221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Saeed H, Rubinfeld I, Sangha R. Vaginal Hysterectomy Outcomes; Complications and Analysis of Risk Factors for 30-Day Readmission. J Minim Invasive Gynecol 2017. [DOI: 10.1016/j.jmig.2017.08.201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Sangha R, Saeed H, Rubinfeld I. Analysis of Risk Factors for Readmission after Hysterectomy: Use of a National Database. J Minim Invasive Gynecol 2017. [DOI: 10.1016/j.jmig.2017.08.204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Sangha R, Saeed H, Bossick A, Wegeinka G. Do Women Express Regret After Hysterectomy? J Minim Invasive Gynecol 2017. [DOI: 10.1016/j.jmig.2017.08.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Karim S, Ding K, Bradbury P, Ellis P, Mittman N, Xiaoqun Sun X, Millward M, Liu G, Sun S, Stockler M, Cohen V, Blais N, Sangha R, Boyer M, Sasidharan R, Lee C, Shepherd F, Goss G, Seymour L, Leighl N. Costs of dacomitinib versus placebo in pretreated unselected patients (pts) with advanced NSCLC: CCTG BR.26. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx375.009] [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: 11/12/2022] Open
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Sangha R, Bossick A, Wegienka G. Association between patient depression level and hysterectomy satisfaction in the United States. Maturitas 2017. [DOI: 10.1016/j.maturitas.2017.03.232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Sangha R, Hijaz M, Jankowski J, Zaza S. Pregnancy outcomes in women undergoing myomectomy aged 40 and older. Maturitas 2017. [DOI: 10.1016/j.maturitas.2017.03.188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Sangha R, Bossick A, Wegienka G. Identification of pre and post hysterectomy patient centered preferences in the United States: Results of a focus group methodology. Maturitas 2017. [DOI: 10.1016/j.maturitas.2017.03.260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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36
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Cabanero M, Sangha R, Sheffield BS, Sukhai M, Pakkal M, Kamel-Reid S, Karsan A, Ionescu D, Juergens RA, Butts C, Tsao MS. Management of EGFR-mutated non-small-cell lung cancer: practical implications from a clinical and pathology perspective. ACTA ACUST UNITED AC 2017; 24:111-119. [PMID: 28490925 DOI: 10.3747/co.24.3524] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [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: 02/07/2023]
Abstract
Starting in the early 2000s, non-small-cell lung cancer (nsclc) subtypes have evolved from being histologically described to molecularly defined. Management of lung adenocarcinomas now generally requires multiple molecular tests at baseline to define the optimal treatment strategy. More recently, second biopsies performed at progression in patients treated with tyrosine kinase inhibitors (tkis) have further defined the continued use of molecularly targeted therapy. In the present article, we focus on one molecular subtype: EGFR-mutated nsclc. For that patient population, multiple lines of tki therapy are now available either clinically or in clinical trials. Each line of treatment is guided by the specific mutations (for example, L858R, T790M, C797S) identified in EGFR. We first describe the various mechanisms of acquired resistance to EGFR tki treatment. We then focus on strategies that clinicians and pathologists can both use during tissue acquisition and handling to optimize patient results. We also discuss future directions for the molecular characterization of lung cancers with driver mutations, including liquid biopsies. Finally, we provide an algorithm to guide treating physicians managing patients with EGFR-mutated nsclc. The same framework can also be applied to other molecularly defined nsclc subgroups as resistance patterns are elucidated and additional lines of treatment are developed.
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Affiliation(s)
- M Cabanero
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON
| | - R Sangha
- Cross Cancer Institute, Edmonton, AB
| | | | - M Sukhai
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON
| | - M Pakkal
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON
| | - S Kamel-Reid
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON
| | | | | | - R A Juergens
- Juravinski Cancer Centre, McMaster University, Hamilton, ON
| | - C Butts
- Cross Cancer Institute, Edmonton, AB
| | - M S Tsao
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON
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Hijaz M, Jankowski J, Sangha R. Factors Affecting Recurrence of Leiomyomas in Older Women (Above Age 40). J Minim Invasive Gynecol 2016. [DOI: 10.1016/j.jmig.2016.08.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Hijaz M, Jankowski J, Sangha R. Is Race and BMI Associated with Leiomyoma Recurrence in Women Above Age 40? J Minim Invasive Gynecol 2016. [DOI: 10.1016/j.jmig.2016.08.784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Sangha R, Bossick A, Wegienka G. Use of Focus Groups to Identify Pre- and Post-Hysterectomy Patient Centered Preferences. J Minim Invasive Gynecol 2016. [DOI: 10.1016/j.jmig.2016.08.785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Petersen S, Rubinfeld I, Buekers T, Sangha R. Analysis of Risk Factors for Urologic Injuries After Minimally Invasive vs Abdominal Hysterectomy. J Minim Invasive Gynecol 2016. [DOI: 10.1016/j.jmig.2016.08.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Rosenberg J, Heath E, Perez R, Merchan J, Lang J, Ruether D, Petrylak D, Sangha R, Smith D, Sridhar S, Gartner E, Vincent M, Chu R, Anand B, Donate F, Melhem-Bertrandt A, Zhang J. Interim analysis of a phase I dose escalation trial of ASG-22CE (ASG-22ME; enfortumab vedotin), an antibody drug conjugate (ADC), in patients (Pts) with metastatic urothelial cancer (mUC). Ann Oncol 2016. [DOI: 10.1093/annonc/mdw373.16] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Tsafrir Z, Aoun J, Papalekas E, Schiff LD, Theoharis E, Hanna R, Sangha R, Eisenstein D. Risk factors for Trachelectomy Following Supracervical Hysterectomy. J Minim Invasive Gynecol 2016; 22:S82-S83. [PMID: 27679351 DOI: 10.1016/j.jmig.2015.08.222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Z Tsafrir
- Minimally Invasive Gynecologic Surgery, Women's Health Services, Henry Ford Hospital, West Bloomfield, Michigan
| | - J Aoun
- Minimally Invasive Gynecologic Surgery, Women's Health Services, Henry Ford Hospital, West Bloomfield, Michigan
| | - E Papalekas
- Minimally Invasive Gynecologic Surgery, Women's Health Services, Henry Ford Hospital, West Bloomfield, Michigan
| | - L D Schiff
- Minimally Invasive Gynecologic Surgery, Women's Health Services, Henry Ford Hospital, West Bloomfield, Michigan
| | - E Theoharis
- Minimally Invasive Gynecologic Surgery, Women's Health Services, Henry Ford Hospital, West Bloomfield, Michigan
| | - R Hanna
- Minimally Invasive Gynecologic Surgery, Women's Health Services, Henry Ford Hospital, West Bloomfield, Michigan
| | - R Sangha
- Minimally Invasive Gynecologic Surgery, Women's Health Services, Henry Ford Hospital, West Bloomfield, Michigan
| | - D Eisenstein
- Minimally Invasive Gynecologic Surgery, Women's Health Services, Henry Ford Hospital, West Bloomfield, Michigan
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Baker-Genaw K, Kokas MS, Ahsan SF, Darnley-Fisch D, Drake S, Goyal N, Inamdar K, Moutzouros V, Prabhakar D, Rolland L, Sangha R, Shreve M, Woodward A. Mapping Direct Observations From Objective Structured Clinical Examinations to the Milestones Across Specialties. J Grad Med Educ 2016; 8:429-34. [PMID: 27413450 PMCID: PMC4936865 DOI: 10.4300/jgme-d-15-00385.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 11/06/2022] Open
Abstract
BACKGROUND Little is known about residents' performance on the milestones at the institutional level. Our institution formed a work group to explore this using an institutional-level curriculum and residents' evaluation of the milestones. OBJECTIVE We assessed whether beginner-level milestones for interpersonal and communication skills (ICS) related to observable behaviors in ICS-focused objective structured clinical examinations (OSCEs) for postgraduate year (PGY) 1 residents across specialties. METHODS The work group compared ICS subcompetencies across 12 programs to identify common beginner-level physician-patient communication milestones. The selected ICS milestone sets were compared for common language with the ICS-OSCE assessment tool-the Kalamazoo Essential Elements of Communication Checklist-Adapted (KEECC-A). To assess whether OSCE scores related to ICS milestone scores, all PGY-1 residents from programs that were part of Next Accreditation System Phase 1 were identified; their OSCE scores from July 2013 to June 2014 and ICS subcompetency scores from December 2014 were compared. RESULTS The milestones for 10 specialties and the transitional year had at least 1 ICS subcompetency that related to physician-patient communication. The language of the ICS beginner-level milestones appears similar to behaviors outlined in the KEECC-A. All 60 residents with complete data received at least a beginner-level ICS subcompetency score and at least a satisfactory score on all 3 OSCEs. CONCLUSIONS The ICS-OSCE scores for PGY-1 residents appear to relate to beginner-level milestones for physician-patient communication across multiple specialties.
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Affiliation(s)
- Kimberly Baker-Genaw
- Corresponding author: Kimberly Baker-Genaw, MD, Henry Ford Hospital, Department of Medical Education, CFP-1, 2799 West Grand Boulevard, Detroit, MI 48202, 313.916.3829, fax 313.916.1394,
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Elmokadem AH, Ansari SA, Sangha R, Prabhakaran S, Shaibani A, Hurley MC. Neurointerventional management of carotid webs associated with recurrent and acute cerebral ischemic syndromes. Interv Neuroradiol 2016; 22:432-7. [PMID: 26922976 DOI: 10.1177/1591019916633245] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [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: 01/24/2016] [Accepted: 01/25/2016] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND A carotid web can be defined as an endoluminal shelf-like projection often noted at the origin of the internal carotid artery (ICA) just beyond the bifurcation. Diagnosis of a carotid web as an underlying cause of recurrent ischemic stroke is infrequent and easily misdiagnosed as an atheromatous plaque. Surgery has traditionally been used to resect symptomatic lesions while there is no enough evidence supporting medical therapy as the sole management. To our knowledge there is only one report about carotid artery stenting (CAS) as a definite management of carotid web and no previous reports of acute large-vessel occlusions undergoing mechanical thrombectomy in the setting of carotid web as the etiology. CASE REPORT We report two cases: The first presented with recurrent ischemic stroke in the same arterial territory and the other with an emergent left middle cerebral artery (MCA) occlusion that underwent endovascular mechanical thrombectomy in which initial computed tomographic angiograms (CTA) suggested carotid web etiologies. Following confirmation with digital subtraction angiography (DSA), both patients ultimately underwent endovascular carotid stenting instead of surgical resection for definitive carotid web treatment. CONCLUSIONS Carotid webs are a rare cause of ischemic stroke in young and middle-aged adults that can readily be identified by CTA. Endovascular management may include emergent mechanical thrombectomy for large-vessel thromboembolic complications, and for definitive treatment with carotid stenting across the carotid web as an alternative to surgical resection and medical management for secondary stroke prevention.
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Affiliation(s)
- A H Elmokadem
- Department of Radiology, Mansoura University, Egypt Department of Radiology, Northwestern University Feinberg School of Medicine, USA
| | - S A Ansari
- Department of Radiology, Northwestern University Feinberg School of Medicine, USA Department of Neurology, Northwestern University Feinberg School of Medicine, USA Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, USA
| | - R Sangha
- Department of Neurology, Northwestern University Feinberg School of Medicine, USA
| | - S Prabhakaran
- Department of Neurology, Northwestern University Feinberg School of Medicine, USA
| | - A Shaibani
- Department of Radiology, Northwestern University Feinberg School of Medicine, USA Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, USA
| | - M C Hurley
- Department of Radiology, Northwestern University Feinberg School of Medicine, USA Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, USA
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Toubia T, Schiff L, Wegienka G, Sangha R. Extended Length of Stay After Robotic-Assisted Hysterectomy: Association with Uterine Weight and Other Risk Factors. J Gynecol Surg 2016. [DOI: 10.1089/gyn.2015.0063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Tarek Toubia
- Department of Women's Health, Henry Ford Health System, Detroit, MI
- Department of Obstetrics and Gynecology, Division of Minimally Invasive Gynecologic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Lauren Schiff
- Department of Women's Health, Henry Ford Health System, Detroit, MI
- Department of Obstetrics and Gynecology, Division of Minimally Invasive Gynecologic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Ganesa Wegienka
- Department of Public Health Sciences, Henry Ford Health System, Detroit, MI
| | - Roopina Sangha
- Department of Women's Health, Henry Ford Health System, Detroit, MI
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Sangha R. Commentary on "The CROWN Initiative: Journal Editors Invite Researchers to Develop Core Outcomes in Women's Health". J Minim Invasive Gynecol 2016; 23:153. [PMID: 26690365 DOI: 10.1016/j.jmig.2015.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 11/30/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Roopina Sangha
- Department of Obstetrics and Gynecology, Henry Ford Hospital and School of Medicine, Detroit, Michigan
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Sangha R. Preoperative Uterine Volume: Does It Predict Symptomatic Fibroid Recurrence After Robotic Myomectomy: A Retrospective Cohort Study. J Minim Invasive Gynecol 2015; 22:S68. [DOI: 10.1016/j.jmig.2015.08.183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Sangha R, Jones K, Havstad S, Wegienka G. Association Between Body Mass Index and Patient-Centered Outcomes After Hysterectomy. J Reprod Med 2015; 60:392-396. [PMID: 26592064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To assess whether body mass index (BMI) was associated with self-reported pain, well-being, or procedure satisfaction in the 3 months after hysterectomy. STUDY DESIGN Prospective cohort study that recruited women undergoing hysterectomy. Data was collected over 1 year for 245 women. RESULTS BMI was not associated with pain either at baseline or in the 3 months after surgery versus no pain; odds ratio [OR] = 1.0, 95% confidence interval [CI] 0.97-1.03, p = 0.88 for a 1 unit increase in BMI) or being fully satisfied with the procedure (versus not fully satisfied; OR = 1.01, 95% CI 0.97-1.04, p = 0.77 for a 1unit increase in BMI). Similarly, patient's perception of well-being was also not influenced by BMI as reflected in their well-being score (0.98 increase in score, 95% CI 0.95-1.02, p = 0.40, for a 1-unit increase in BMI). CONCLUSION The data from this prospectively studied cohort of women who had undergone hysterectomy suggest that BMI is not associated with self-report of pain, well-being, -or procedure satisfaction in the 3 month after surgery.
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Abstract
Targeting the epidermal growth factor receptor (egfr) pathway has become standard practice for the treatment of advanced non-small-cell lung cancer. Compared with chemotherapy, egfr tyrosine kinase inhibitors (tkis) have been associated with improved efficacy in patients with an EGFR mutation. Together with the increase in efficacy comes an adverse event (ae) profile different from that of chemotherapy. That profile includes three of the most commonly occurring dermatologic aes: acneiform rash, stomatitis, and paronychia. Currently, no randomized clinical trials have evaluated the treatments for the dermatologic aes that patients experience when taking egfr tkis. Based on the expert opinion of the authors, some basic strategies have been developed to manage those key dermatologic aes. Those strategies have the potential to improve patient quality of life and compliance and to prevent inappropriate dose reductions.
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Affiliation(s)
| | - N B Leighl
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON
| | - J Rothenstein
- R.S. McLaughlin Durham Regional Cancer Centre, Lakeridge Health, Oshawa, and Department of Oncology, Queen's University, Kingston, ON
| | - R Sangha
- Cross Cancer Institute, Edmonton, AB
| | - D Stewart
- The Ottawa Hospital and University of Ottawa, Ottawa, ON
| | - K Papp
- Probity Medical Research, Waterloo, ON
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Sangha R, Strickler R, Dahlman M, Havstad S, Wegienka G. Myomectomy to Conserve Fertility: Seven-Year Follow-Up. Journal of Obstetrics and Gynaecology Canada 2015; 37:46-51. [DOI: 10.1016/s1701-2163(15)30362-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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