PREDICT-GTN 1: Can we improve the FIGO scoring system in gestational trophoblastic neoplasia?

Gestational trophoblastic neoplasia (GTN) patients are treated according to the eight-variable International Federation of Gynaecology and Obstetrics (FIGO) scoring system, that aims to predict first-line single-agent chemotherapy resistance. FIGO is imperfect with one-third of low-risk patients developing disease resistance to first-line single-agent chemotherapy. We aimed to generate simplified models that improve upon FIGO. Logistic regression (LR) and multilayer perceptron (MLP) modelling (n = 4191) generated six models (M1-6). M1, all eight FIGO variables (scored data); M2, all eight FIGO variables (scored and raw data); M3, nonimaging variables (scored data); M4, nonimaging variables (scored and raw data); M5, imaging variables (scored data); and M6, pretreatment hCG (raw data) + imaging variables (scored data). Performance was compared to FIGO using true and false positive rates, positive and negative predictive values, diagnostic odds ratio, receiver operating characteristic (ROC) curves, Bland-Altman calibration plots, decision curve analysis and contingency tables. M1-6 were calibrated and outperformed FIGO on true positive rate and positive predictive value. Using LR and MLP, M1, M2 and M4 generated small improvements to the ROC curve and decision curve analysis. M3, M5 and M6 matched FIGO or performed less well. Compared to FIGO, most (excluding LR M4 and MLP M5) had significant discordance in patient classification (McNemar's test P < .05); 55-112 undertreated, 46-206 overtreated. Statistical modelling yielded only small gains over FIGO performance, arising through recategorisation of treatment-resistant patients, with a significant proportion of under/overtreatment as the available data have been used a priori to allocate primary chemotherapy. Streamlining FIGO should now be the focus.     

Fear of cancer recurrence in lymphoma survivors: A descriptive study

Abstract

Objectives: Fear of cancer recurrence (FCR) is a common experience among cancer survivors and often persists after the termination of cancer treatments. The purpose of this paper was to evaluate FCR in survivors of Hodgkin’s and diffuse large B-cell lymphomas, given a high rate of survivorship in this patient population.

Research Approach: The parent study was a multi-site, cluster-randomized trial to assess a communication skills intervention: survivorship planning consultation (versus a time-attention control - wellness rehabilitation intervention) to promote transition to survivorship.

Participants & Methodological Approach: 199 patients enrolled in the study and completed a survivorship (or control) consultation one-month after receiving the news of their survivorship status; 141 of those patients (n?=?92 experimental arm, n?=?49 control arm) completed an interview at their 6-month follow-up consultation. In the interview, participants described frequency of FCR, causes of FCR, coping mechanisms, and specific things oncologists said to reduce FCR. Both qualitative and quantitative methods were utilized for analyzing participant responses.

Findings: The majority (88%) of participants reported experiencing FCR, with a higher number of participants in the experimental arm significantly more likely to endorse FCR compared to the control group participants. The main causes of FCR were having medical appointments and concerns about potential relapse and secondary cancers. Participants endorsed utilizing self-sufficient coping mechanisms. As well, participants reported that oncologists most frequently cited specific cure rates of lymphoma to reduce patients’ FCR.

Interpretation & Implications for Psychosocial Providers: Communication skills training programs should emphasize FCR in survivorship consultations.     

Looking back on wartime service: Reminiscence by James G. Van Straten

In this article we highlight the reminiscence of a distinguished Veteran of the Vietnam War. The narrative describes his wartime service in Vietnam and the legacy of these experiences across his military career and subsequent civilian life. The individual profiled is not intended to represent all Veterans who served in the Vietnam War. In fact, this is a very unique individual; a highly educated, career officer and committed Catholic who served in various roles within the United States Army Medical Department. This narrative represents memories and reflections from his military career and in his subsequent post-military civilian life.     

“I used to be an addict. I’m still an addict. I’m always going to be a recovering addict”: Understanding the challenges of individuals seeking recovery

Background and Objective: Although preventable, substance addiction has become one of the most prominent public health problems facing the nation. As a result, treatment programs and centers have focused resources and efforts on aiding individuals on their path to long-term recovery. However, the constant threat, reinforced by high incidence, of relapse presents a major obstacle to long-term recovery. Relapse prevention programs are designed to target social and psychological factors contributing to lapses in sobriety. Yet, the exact factors that can impact long-term recovery and prevent or lower the instances of relapse are not always clear. The current study explores the major contributors to relapse as experienced in a male residential treatment center.

Methods: The data were gathered through 31 in-depth interviews in a residential halfway house treatment facility for substance use recovery.

Results: The results of the study underscored social support and interpersonal relationships as major factors impacting long-term recovery. More specifically, lack of efficacy in managing interpersonal relationships and building new support networks were identified as essential barriers to long-term recovery.

Conclusions: The management of interpersonal relationships seems to be a key to long-term recovery, which emphasizes the need for strategies that underscore the development of positive relationships that will strengthen resistance to relapse and long-term recovery.