Influence of coping with prostate cancer threat on frequency of digital rectal examinations

OBJECTIVES: To determine the role of personality variables in coping with cancer threat in the receipt of digital rectal examinations among men from 7 ethnic subpopulations composing 3 major ethnic groups. METHODS: Three hundred eight men were assessed on how often they obtained digital rectal exams and their likelihood of coping with a hypothetical cancer diagnosis. RESULTS: There were ethnic disparities in screening frequency that were not accounted for by demographic/background variables. Coping styles that reflect problem solving, use of social support, and avoidance provided unique and additional variance in understanding these disparities. CONCLUSIONS: Cancer researchers and educators must account for heterogeneity within typical major ethnic groups, as well as consider the role of personality variables, as they differentially predict outcomes in ethnic subpopulations.     

Assessment of quality of life in lung cancer patients

Objetives: The aim of this study was to describe lung cancer patients' quality of life, measuring physical, psychological and social parameters, and general and specific symptoms of the disease using different questionnaires.Methods: 103 primary lung cancer patients who were between 20 and 80 years old and recruited during one year were included. All patients fulfilled the generic health related quality of life (HRQoL) questionnaire SF-36 and the specific EORTC-C30. Also sociodemographic and clinical important data were collected. Differences in aspects of perceived quality of life by diagnostic group and stage were analysed.Results: The results indicate that the patients with a higher disease stage had worse perception of their quality of life in comparison with patients in a lower stage of the disease. Likewise, small cell lung cancer patients, overall, showed a worse perception of their quality of life than non-small cell lung cancer patients. These differences were shown either by generic and the specific questionnaire scores.Conclusions: The results obtained in the study show that the SF-36 and EORTC capture the differences in the perceived quality of life in patients by diagnosis and evolution stage of the disease. All quality of life areas were already affected at the moment of the diagnosis of the disease. The scores of both questionnaires are coherent with clinical evaluation, based on the clinical stage, which support the discriminative validity of those instruments.     

基于机器学习的肺癌图像辅助诊断应用研究

目的:为满足肺癌临床早期筛查需求,拟在CT图像分析及病理细胞学诊断中建立智能化辅助筛查工具,提高图像分析效率,降低医生工作量。方法:在对肺癌临床早期诊断技术研究基础上,提出基于机器学习建立肺癌CT及病理切片图像辅助分析工具的方案;基于人工智能辅助诊断理念,采用图像模式增强、分割及机器学习分类模型等方法构建肺癌图像辅助诊断系统,以解决肺癌早筛的推广及应用范围受区域医疗资源分布限制的问题。结果:通过构建肺癌图像辅助诊断系统,实现了CT图像肺结节分割、数字病理细胞及细胞核分割、CT肺结节辅助筛查及细胞及细胞核辅助筛查等功能;系统阳性病例的辅助诊断准确率接近临床低年资医生的诊断水平,平均筛查时间缩短58%,为肺癌早期筛查创造条件。结论:通过构建肺癌图像辅助诊断系统,提高了图像分析效率,降低医生工作量,将一定程度上缓解区域医疗资源不平衡,为临床诊断提供辅助筛查支持,有助于提高肺癌早期筛查在临床的应用范围。     

低剂量螺旋CT和痰液基薄层细胞学联合筛查社区肺癌高危人群的研究

目的 评价低剂量螺旋CT（low-dose computed tomography, LDCT）和痰液基薄层细胞学检测（thinprep cytologic test, TCT）对社区肺癌高危人群的联合筛查效果。方法 对2013年8月~2014年9月在社区招募符合本研究高危人群定义的3 708名东莞本地居民进行肺癌筛查。肺癌高危人群定义为符合下列任何一项的40岁以上者:20包年以上的吸烟史,肺癌家族史,肺部既往病史,职业接触史或被动吸烟史。发现至少一个直径≥4 mm 非钙化结节为LDCT筛查的阳性结果;细胞学重度不典型增生或镜检可见癌细胞为TCT检查的阳性结果。结果 LDCT肺部结节的检出率为12.59%（467/3 708）。经病理证实,LDCT筛查阳性人群中共确诊肺癌56例,检出率为1.51%（56/3 708）。TCT的阳性检出率为1.91%（71/3 708）。TCT阳性人群中共确诊肺癌36例,肺癌检出率为0.97%（36/3 708）。本次联合筛查共确诊肺癌58例,非小细胞肺癌41例,其中0～Ⅰ 期22例,早期诊断率为53.66%（22/41）。结论 LDCT和TCT联合筛查肺癌高危人群有助于提高肺癌的早期诊断率和检出率,降低筛查的假阳性比例。     

Experience of health changes and reasons for delay in seeking care: a UK study of the months prior to the diagnosis of lung cancer

The problem of 'delay' in diagnosing cancer as a result of late presentation by individuals who have symptoms, or through doctor or hospital system failures, are currently the subject of close attention as part of broader initiatives to reduce deaths from cancer. However, in lung cancer there has been a generally held view that 'late' diagnosis is inevitable because of the biomedical difficulties in detecting the disease at an early stage. Data about events recalled prior to diagnosis from an interview study with 22 individuals recently diagnosed with operable (early stage) and inoperable (late stage) lung cancer are reported. Findings reveal that individuals, regardless of their disease stage, or their social background failed to recognise symptoms that they experienced over many months prior to their eventual diagnosis as serious and warranting medical attention. Symptoms, even when severe, were instead attributed to everyday causes and were not interpreted as indicative of ill-health. There was a reluctance to seek help for symptoms among some because they were unsure whether what they were experiencing was normal or not, and in one case because as a smoker, the individual felt 'unworthy' of medical care. This study suggests that previous assumptions that focus on individual or psychological factors in the processes of delay in cancer diagnosis need revisiting and the broader social influences that may affect the timing of diagnosis among people with lung cancer should be considered.     

螺旋CT诊断肺癌的应用与CT特征研究

目的观察分析螺旋CT诊断肺癌的应用效果与CT特征。方法选取本院2018年2月-2019年2月收治的117例疑似肺癌患者,所有疑似肺癌患者均进行螺旋CT检查。采用统计学分析多层螺旋CT检查对不同类型肺癌(周围型肺癌、中央型肺癌、弥漫型肺癌)的正确诊断率、误诊率以及病理组织检查和多层螺旋CT检查不同病理分型结果、多层螺旋CT特征。结果病理组织检查和多层螺旋CT检查不同病理分型结果比较无统计学意义(P> 0.05),多层螺旋CT检查周围型肺癌患者的正确诊断率显著高于中央型肺癌患者、弥漫型肺癌患者,多层螺旋CT检查周围型肺癌患者的误诊率显著低于中央型肺癌患者、弥漫型肺癌患者(P <0.05);多层螺旋CT特征:(1)肺癌病灶呈现结节;(2)肺癌肿瘤边界清晰;(3)病灶呈现小片形状且边界较为模糊。结论螺旋CT诊断肺癌的应用价值较高,能够有效分辨和诊断肺癌病灶。     

肺癌患者呼出气冷凝液p16基因甲基化检测

目的:检测肺癌患者呼出气冷凝液中p16基因异常甲基化情况,探讨呼出气冷凝液中p16基因异常甲基化改变作为肺癌临床辅助诊断分子生物学标志物的可能性。方法:利用甲基化特异性聚合酶链反应(MS-PCR)方法,检测20例病理确诊肺癌患者的呼出气冷凝液标本中p16基因的甲基化情况。结果:20例确诊肺癌患者呼出气冷凝液中p16基因异常甲基化阳性例数为8例(40.0%),其中肺鳞癌、腺癌、小细胞癌患者呼出气冷凝液标本的阳性率分别为40.0%,33.3%和50.0%。p16基因的甲基化异常改变与肿瘤的分期、分型无明显相关性。但是呼出气冷凝液中p16基因甲基化水平均为部分甲基化状态。结论:用呼出气冷凝液标本检测甲基化来诊断和筛选肺癌,p16基因可能不是一个理想的候选基因。     

Cancer survival in New Zealand: ethnic, social and geographical inequalities

This study investigated the combined effects of ethnicity, deprivation and geographical access to health services on the likelihood of survival from a range of common cancers in New Zealand. Individual cancer registry records of 99,062 cases of melanoma, colorectal, lung, breast and prostate cancers diagnosed in the period 1994-2004 were supplemented with small area information on social deprivation and estimates of travel time to the nearest primary care and cancer centre. Logistic regression was used to identify the variables associated with advanced extent of the disease at diagnosis. Adverse influences on survival were investigated using Cox proportional hazards models. Controlling for age and gender, Māori and Pacific peoples' ethnicity was strongly associated with poorer survival, partly because ethnicity was also linked to the likelihood of advanced disease at diagnosis. Living in a deprived area was related to later stage presentation and poorer survival of people with melanoma, but there was no other evidence that living in a deprived area or in a remote location were associated with later stage presentation. Some disease-specific trends in survival were observed. Colorectal and lung cancers were more likely to be fatal for people living in deprived areas, survival from prostate cancer was poor for men living remote from primary care, and people with colorectal, breast and prostate cancers had adverse survival chances if they lived distant from a cancer centre.     

非小细胞肺癌患者血清中TSGF及CA125水平检测的意义

目的探讨恶性肿瘤特异性生长因子(TSGF)和糖类抗原-125(CA125)血清水平检测对非小细胞肺癌(NSCLC)患者诊断的临床价值。方法选取50例NSCLC患者,及50例良性肺部病变患者,检测血清TSGF和CA125水平,比较不同组别患者及肺癌患者不同病理类型、不同临床分期血清TSGF和CA125的表达水平。结果血清TS-GF和CA125水平在肺癌组明显高于肺良性病变组(P<0.001);肺癌患者CA125表达水平与组织类型有关,肺腺癌明显高于肺鳞癌(P<0.01);肺癌患者血清TSGF和CA125的阳性率与NSCLC临床分期有关,临床分期越晚,其阳性率越高。结论 CA125及TSGF均对肺癌的辅助诊断具有一定价值,临床上需要结合症状、影像学及病理学综合判断,为NSCLC提供更好的诊疗效果。     

Survival of patients with surgery for lung cancer.

INTRODUCTION: Lung cancer is the leading cause of death in oncological diseases all over the world. It is a major health problems in Bulgaria. Early diagnosis is of great significance for improving survival in this group of patients. OBJECTIVE: The aim of this study was to analyze survival of patients with surgery for lung cancer. MATERIALS AND METHODS: Retrospective information for all 86 patients with surgery for lung cancer during the period 1995-1998 was obtained from the surgery protocols in the Clinic of Thoracic and Abdominal Surgery at the Higher Medical Institute (Plovdiv, Bulgaria). However, relevant follow-up data were found only for 50 patients. Medical histories were provided by the Plovdiv Oncological Center. Kaplan-Meier analysis was applied to study survival of patients. The log rank test was used to compare cumulative survival functions between groups of patients with different stage at diagnosis. Univariate Cox regression analysis allowed the development of a model to assess the influence of the stage at diagnosis on cumulative survival. RESULTS: Survival was assessed till June 1998. Mean survival period was 15 months (95% CI 13, 18). Patients were divided into two sub-groups: group A (stage I and II) and group B (stage III and IV). The analysis showed a marginally significant difference in cumulative survival between two groups (p = 0.0599). The mean survival period of patients from group A was 18 months (95% CI 14, 22) while for group B it was 12 months (95% CI 9, 16). Univariate Cox regression model showed that the relative risk of patients in group B to patients in group A is 3.2 (95% CI 1.11, 9.06). Early diagnosis of lung cancer is of crucial importance for surgery management and prognosis in such patients.     

Factors important to psychosocial adjustment to cancer: a review of the evidence

Systematic observations have revealed that cancer patients experience a wide array of emotional reactions. Because of limited helping resources, as well as the possibility of prevention, it would be useful to identify those cancer patients at risk for the development of significant psychiatric difficulties and psychosocial maladjustment. Many investigators have proposed, but not substantiated factors which seem to be associated with such problems following cancer diagnosis. This report reviews clinically noted or theoretically-derived factors which have been tested empirically for relationships with various aspects of psychosocial adjustment. Certain specific cancer sites have been noted to be associated with psychosocial problems. A specific biological basis for psychiatric problems associated with certain diseases has been proposed for multiple myeloma, lung tumors and pancreatic cancer. A number of chemotherapy agents are now recognized as accounting for presumed psychiatric symptoms. While studies relating age, sex, marital or socioeconomic status with psychosocial problems have found no consistent associations, social support has been demonstrated as a significant factor in adjustment to cancer. Studies of the relation of adaptation and the patient's psychological situation such as degree of pessimism or anxiety, personality characteristics, prior experience with the death of a close friend or relative or religious beliefs have been inconclusive. Many studies have used measures of questionable external validity and others employed unvalidated subjective ratings. It is only recently that there are instruments considered reliable and valid for research in this area and even these instruments have not been extensively validated. Finally, this paper reviews several major design problems which have impaired identification of predictive variables and provides suggestions for future research.     

Roles of religious involvement and social support in the risk of colon cancer among Blacks and Whites

This population-based case-control study of Blacks and Whites in North Carolina (1996-2000) examined the relation between social ties, etiology of colon cancer, and stage of disease at diagnosis. Interviews were conducted with 637 cases and 1,043 controls. Information was collected on two dimensions of social ties, structural (network) dimensions and functional (emotional and tangible help) dimensions. Infrequent attendance at religious services (less than once per month) was associated with a regional/advanced stage of colon cancer at diagnosis in Whites (odds ratio (OR) = 1.67, 95% confidence interval (CI): 1.09, 2.57; p for trend = 0.02) but not in Blacks (OR = 1.21, 95% CI: 0.66, 2.21; p for trend = 0.80). Among Blacks, minimal emotional support was strongly associated with risk of colon cancer (OR = 4.62, 95% CI: 2.06, 10.35; p for trend < 0.001) and with both local (OR = 3.69, 95% CI: 1.08, 12.69; p for trend < 0.001) and advanced (OR = 5.10, 95% CI: 2.03, 12.82; p for trend < 0.01) disease. No associations between emotional support and risk of colon cancer or stage of disease were observed among Whites. These results suggest that certain characteristics of social ties are associated with both risk of and prognostic indicators for colon cancer.     

MSCT联合多平面重组技术对磨玻璃密度结节样肺癌患者诊断价值分析

目的 研究多排螺旋CT(MSCT)联合多平面重组技术对磨玻璃密度结节样肺癌患者的诊断价值.方法 回顾性分析大连市中心医院从2018年1月—2020年1月收治的疑似磨玻璃密度结节样肺癌患者112例的病历资料.以手术病理组织活检结果为金标准,比较常规轴位MSCT图像和MSCT联合多平面重组技术诊断磨玻璃密度结节样肺癌的效能...     

Diagnosis,treatment, and prognosis of lung cancer in the Manche (France) (1997-1999) according to patients socioeconomic characteristics

BACKGROUND: In France, data on social environment influence on cancer management and prognosis are rare and no study has been conducted on lung cancer. This study was designed to investigate the associations between place of residence and occupation class, and diagnosis, treatment and prognosis of lung cancer. METHODS: The study population consisted of the 585 cases of lung cancer collected by the cancer registry of the Manche department (France) over a three-year period (1997-1999). Distribution of qualitative variables was tested using chi(2) test. Multivariate analysis were conducted using logistic regressions. Differences in actuarial survival were tested using log-rank test. RESULTS: Difference in diagnostic conditions did not demonstrate any prominence by social characteristics. People living in rural areas did however have a higher probability of therapeutic abstention than people living in urban areas (adjusted odds ratio=2.20 [1.18-4.10]). Similarly, people without any occupational activity had a probability of therapeutic abstention higher than people with an occupational activity (adjusted odds ratio=3.40 [1.99-5.80]). Moreover, occupational class and place of residence had a significant influence on the place of diagnosis and treatment, lower class and rural people being less often managed in university hospitals. Regarding prognosis, our results do not give prominence to difference in survival according to social characteristics. CONCLUSION: This study suggests that the type of center providing patient care and the nature of treatment given could be associated with the socioeconomic status of the patient. Nevertheless, due to the small sample size, further studies in a larger series would be required to make any formal conclusion.     

Tendance,stade, histologie du cancer bronchopulmonaire chez les femmes dans l’Hérault,France

BackgroundIn France, lung cancer is the third most common cancer and the third leading cause of cancer death in women. The main objective of this study is to analyse specificities of lung cancer in the female population in an administrative district in France, focusing on histology, staging and trends over time.MethodsIncidence data from 1987 to 2004 were extracted from the Hérault cancer registry. The variables of interest considered at diagnosis were stage, histology and age. Mortality data were extracted from the CépiDc–Inserm database for the same period.ResultsAmong the 6,650 patients studied, 16.8% were women. 18.3% of whom were aged less than 50 at diagnosis, (9.9% of men, p < 0.001). Lung cancer incidence is increasing in the female population (+6.4% per year) as well as lung cancer mortality (+3.5% per year). This occured faster for adenocarcinoma, young women and stages III–IV.ConclusionThis population-based study confirmed the specific features of lung cancer in women: younger age at diagnosis, adenocarcinoma and stage at diagnosis with poor prognosis. These results raise the question of possible differences to lung cancer susceptibility between males and females.     

Cancer Survivors’ Social Context in the Return to Work Process: Narrative Accounts of Social Support and Social Comparison Information

Purpose Returning to work is a process that is intertwined with the social aspects of one’s life, which can influence the way in which that person manages their return to work and also determines the support available to them. This study aimed to explore cancer patients’ perceptions of the role of their social context in relation to returning to work following treatment. Methods Twenty-three patients who had received a diagnosis of either urological, breast, gynaecological, or bowel cancer participated in semi-structured interviews examining general perceptions of cancer, work values and perceptions of the potential impact of their cancer diagnosis and treatment on work. Interviews were analysed using the iterative process of Framework Analysis. Results Two superordinate themes emerged as influential in the return to work process: Social support as a facilitator of return to work (e.g. co-workers’ support and support outside of the workplace) and Social comparison as an appraisal of readiness to return to work (e.g. comparisons with other cancer patients, colleagues, and employees in other organisations or professions). Conclusions Two functions of the social context of returning to work after cancer were apparent in the participants’ narrative: the importance of social support as a facilitator of returning to work and the utilisation of social comparison information in order to appraise one’s readiness to return to work. The role of social context in returning to work has largely been absent from the research literature to date. The findings of this study suggest that social support and social comparison mechanisms may have a significant impact on an individual’s successful return to the workplace.     

Sources of support and the physical and mental well-being of young women with breast cancer.

Women following the stress resulting from the diagnosis and treatment for breast cancer draw resources from their network of friends and relatives. These resources include both emotional support and instrumental resources such as getting a ride to a medical appointment. Emotional support buffers the effects of the stresses they face and improves their mental well-being while the existence, rather than the use, of instrumental supports is positively related to physical well-being. These hypotheses are tested on a population-based cohort of 336 women in the United States, diagnosed and treated for breast cancer when aged 50 or less. Most are married (65%), work (75%), have dependent children (63%), are white (70%), and had a mastectomy (51%). Results of the multi-variate analyses indicate that consistent with predictions, controlling for socio-demographic and treatment-related variables, the size of the social network was related to greater emotional and instrumental support, and greater emotional support was related to better mental well-being. Contrary to predictions, greater use of instrumental resources was related to poorer physical well-being. The results indicate the importance of social resources on well-being following life-threatening illness.     

Cancer of the Colorectum in Maine, 1995-1998: Determinants of Stage at Diagnosis in a Rural State

CONTEXT: Despite screening for colorectal cancer, mortality in the United States remains substantial. In northern New England, little is known about predictors of stage at diagnosis, an important determinant of survival and mortality. PURPOSE: The objective of this study was to identify predictors of late stage at diagnosis for colorectal cancer in a rural state with a predominantly white population and a large Franco-American minority. METHODS: Incident cases from 1995-1998 were obtained from the Maine Cancer Registry. Individual-level variables (age, sex, race, French ethnicity by surname, and payer) and contextual/town-level variables (socioeconomic status, population density, Franco ancestry proportion, distance to health care, and weather) were modeled with multiple logistic regression for late stage. FINDINGS: Increasing distance to primary care provider was associated with late stage for colorectal cancer. Compared to patients aged > or =85 years, those aged 65-84 years were less likely to be diagnosed late, while those aged 35-49 years were more likely--although not significantly--to have late stage at diagnosis. Associations were not found with socioeconomic variables. CONCLUSIONS: The finding regarding distance to primary care may be consistent with studies showing that rurality and distance to care predict reduced utilization of health care services and worse health outcomes. The finding regarding age has implications for the education of younger high-risk patients and their physicians. The absence of positive findings with regard to socioeconomic variables may stem from the uniquely mixed sociodemographic profiles in rural and urban regions of Maine. Further research should refine these and other contextual measures to elucidate effects on rural health and should further evaluate the utility of assigning French ethnicity by surname in order to identify health disparities.     

Lifestyle risk factors for cancer: the relationship with psychosocial work environment

BACKGROUND: Psychosocial work characteristics (job demands, control, support, job strain and iso-strain [high job strain combined with social isolation at work]) may be linked to cancer risk, by affecting cancer-related lifestyles like smoking, high alcohol consumption, low intake of fruits and vegetables and lack of physical activity. METHODS: Cross-sectional data obtained from 3309 respondents participating in an ongoing prospective cohort study in the Netherlands on psychosocial factors and cancer risk were used to study the association between psychosocial job characteristics and lifestyle. Information on job characteristics and risk factor prevalence was collected from 20-65-year-old men and women, through self-administered questionnaires. Multiple logistic and linear regression analyses were undertaken by gender, with adjustment for age and education. RESULTS: No differences in the prevalence of lifestyle risk factors for cancer were found amongst the psychosocial work characteristics studied. Moreover, little evidence was found for a relation between job (or iso-) strain and cancer-related lifestyles in multivariate analyses. CONCLUSIONS: The present study found no support for the hypothesis that job strain or iso-strain are associated with a cancer-related lifestyle. Further research on the role of other psychosocial factors-like personality or social support outside work-in mediating associations between job characteristics and lifestyle, is warranted.