Feasibility and delivery of patient-reported outcomes in clinical practice among racially diverse bladder and prostate cancer patients

ObjectiveTo assess the feasibility of enrollment and collecting patient-reported outcome (PRO) data as part of routine clinical urologic care for bladder and prostate cancer patients and examine overall patterns and racial variations in PRO use and symptom reports over time.Subjects/Patients and MethodsWe recruited 76 patients (n = 29 Black and n = 47 White) with prostate or bladder cancer at a single, comprehensive cancer center. The majority of prostate cancer patients had intermediate risk (57%) disease and underwent either radiation or prostatectomy. Over half (58%) of bladder cancer patients had muscle invasive disease and underwent cystectomy.Patients were asked to complete PRO symptom surveys using their preferred mode [web- or phone-based interactive voice response (IVR)]. Symptom summary reports were shared with providers during visits. Surveys were completed at 3 time points and assessed urinary, sexual, gastrointestinal, anxiety/depression, and sleep symptoms. Feasibility of enrollment and survey completion were calculated, and linear mixed effects models estimated differences in outcomes by race and time.ResultsSixty three percent of study participants completed all PRO measures at all 3 time points. Black patients were more likely to select IVR as their survey mode (40% vs. 13%, P < 0.05), and less likely to complete all surveys (55% vs. 74%, P = 0.13). Patients using IVR were also less likely to complete all surveys (41% vs. 69%, P = 0.046).ConclusionsReported preferences for survey mode and completion rates differ by race, which may influence survey completion rates and highlight potential obstacles for equitable implementation of PROs into clinical care.     

A national cross-sectional survey of financial toxicity among bladder cancer patients

ObjectiveFinancial toxicity (FT) has been defined as the patient-level impact of the costs of cancer care. Our objective was to better characterize FT among bladder cancer patients as well as oncologic, demographic and insurance characteristics related to FT.MethodsWe conducted a cross-sectional survey of the Bladder Cancer Advocacy Network Patient Survey Network using the validated COST (COmprehensive Score for financial Toxicity) questionnaire. Our primary outcome was relative degree of FT, with lower COST scores corresponding to worse FT. Wilcoxon rank sum tests and multiple regression were used to evaluate differences in demographic, diagnostic and treatment characteristics as they related to degree of FT.ResultsAmong 226 patients, median age was 68 years with 64% male, 83% married, and 49% with Medicare with supplemental insurance. Respondents reported an average of 65 months since diagnosis, with 62% reporting noninvasive disease. Mean COST was 28.4 (range 0–44). On multivariable analysis, patients who were younger, with a household annual income less than $50,000, not retired, or with insurance that was neither Medicare nor employer paid were significantly more likely to have worse FT. A majority of respondents (63.5%) agreed or strongly agreed that they would be interested in discussing cost in the context of their treatment preferences, independent of COST score (P = 0.24).ConclusionsA national cross-sectional survey demonstrated high prevalence of FT which was worse among younger patients with lower incomes, not retired, and without employer-paid or Medicare insurance. Most patients preferred to discuss treatment costs with their bladder cancer provider.     

Bilateral immediate two-stage breast reconstruction in patients with unilateral breast cancer: Outcomes analysis and risk assessment

IntroductionContralateral prophylactic mastectomy has the potential to decrease the occurrence of cancer and reduce psychological burden. However, it is known that complications after bilateral mastectomy are higher compared with unilateral mastectomy. Our goal was to evaluate outcomes of immediate breast reconstruction in patients undergoing bilateral mastectomy and to compare complication rates between therapeutic and prophylactic sides.Patients and MethodsElectronic medical records of patients with unilateral breast cancer who underwent bilateral mastectomy and immediate reconstruction with expanders were reviewed. Postoperative complications were compared between therapeutic and prophylactic mastectomy sides.ResultsSixty-two patients were analyzed. The overall complication rate after both stages was 23.9% on the therapeutic side and 16.5% on the prophylactic side. Infection was the most common complication on both sides. All infections on the prophylactic mastectomy side were successfully treated with intravenous (IV) antibiotics (salvage rate of 100%), whereas 35.7% of infected tissue expander/implants on the therapeutic mastectomy side were explanted despite treatment.ConclusionCareful counselling of patients undergoing elective contralateral prophylactic mastectomy is essential as complications can develop in either breast after reconstruction.     

A two-compartment kinetic model: Rigorous and approximate solutions

We have found an approximate solution of a two-compartment kinetic model. The model considered allows exchange of tracer between the two compartments, and loss of this tracer from one compartment. This solution was used to calculate the turnover rates of the two compartments from the retention of the tracer in the model. Hence, by measuring in a whole body counter the retention of an isotope tracer in such a system, it is possible to calculate the turnover rates of the two compartments of the system. Using an English Electric KDF 9 computer to solve 64 stated models, we have been able to define the range of kinetic constants over which the use of the mathematical approximation is justifiable.

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Zusammenfassung Wir fanden eine Näherungsgleichung für ein kinetisches 2-Kompartment-Verteilungsmodell. Das Modell erlaubt den Austausch von Tracersubstanzen zwischen zwei Räumen und die Angabe des Tracers aus einem Raum. Die Gleichung wurde verwendent, um die Umsatzrate in den zwei Räumen nach der Retention des Tracers im Modell zu berechnen. Durch Messung der Retention eines Isotops in einem derartigen System mit dem Ganzkörperzähler ist es dann möglich, die Umsatzraten in beiden Verteilungsräumen zu berechnen. Ein English Electric KDF 9 Computer, der 64-stufige Vorlagen löst, ermöglicht es, den Bereich der kinetischen Komponenten zu definieren, über welchen die Verwendung der mathematischen Nährung gerechtfertigt ist.

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Résumé Nous avons trouvé une solution approximative d'un modèle cinétique à 2 compartiments. Le modèle considéré perment l'échange du traceur entre 2 compartiments et la perte de ce traceur à partir d'un seul compartiment. Cette solution est utilisée pour calculer les taux de renouvellement des 2 compartiments à partir de la rétention du traceur dans ce modèle. Ainsi, en mesurant la rétention de l'isotope traceur dans un tel système à l'aide d'un comptage «in toto» il est possible de calculer les taux de renouvellement des 2 compartiments du système.En utilisant un calculateur électronique KDF 9 pour résoudre 64 modèles établis, nous avons été capables de préciser les limites des constantes cinétiques dans lesquelles l'utilisation de l'approximation máthématique est justifiée.

     

Maternal–infant interaction quality is associated with child NR3C1 CpG site methylation at 7 years of age

Objective

Infancy is both a critical window for hypothalamic–pituitary–adrenal (HPA) axis development, and a sensitive period for social–emotional influences. We hypothesized that the social–emotional quality of maternal–infant interactions are associated with methylation of HPA-axis gene NR3C1 later in childhood.

Methods

Using a subsample of 114 mother-infant pairs from the Avon Longitudinal Study of Parents and Children (ALSPAC), linear regression models were created to predict variance in methylation of seven selected CpG sites from NR3C1 in whole blood at age 7 years, including the main predictor variable of the first principal component score of observed maternal–infant interaction quality (derived from the Thorpe Interaction Measure at 12 months of age) and covariates of cell-type proportion, maternal financial difficulties and marital status at 8 months postnatal, child birthweight, and sex.

Results

CpG site cg27122725 methylation was negatively associated with warmer, more positive maternal interaction with her infant (β = 0.19, p = .02, q = 0.13). In sensitivity analyses, the second highest quartile of maternal behavior (neutral, hesitant behavior) was positively associated with cg12466613 methylation. The other five CpG sites were not significantly associated with maternal–infant interaction quality.

Conclusions

Narrow individual variation of maternal interaction with her infant is associated with childhood methylation of two CpG sites on NR3C1 that may be particularly sensitive to environmental influences. Infancy may be a sensitive period for even small influences from the social–emotional environment on the epigenetic determinants of HPA-axis function.