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101.
Allison W. Kurian Daphne Y. Lichtensztajn Theresa H. M. Keegan Rita W. Leung Sarah J. Shema Dawn L. Hershman Lawrence H. Kushi Laurel A. Habel Tatjana Kolevska Bette J. Caan Scarlett L. Gomez 《Breast cancer research and treatment》2013,137(1):247-260
Chemotherapy regimens for early stage breast cancer have been tested by randomized clinical trials, and specified by evidence-based practice guidelines. However, little is known about the translation of trial results and guidelines to clinical practice. We extracted individual-level data on chemotherapy administration from the electronic medical records of Kaiser Permanente Northern California (KPNC), a pre-paid integrated healthcare system serving 29 % of the local population. We linked data to the California Cancer Registry, incorporating socio-demographic and tumor factors, and performed multivariable logistic regression analyses on the receipt of specific chemotherapy regimens. We identified 6,004 women diagnosed with Stage I–III breast cancer at KPNC during 2004–2007; 2,669 (44.5 %) received at least one chemotherapy infusion at KPNC within 12 months of diagnosis. Factors associated with receiving chemotherapy included <50 years of age [odds ratio (OR) 2.27, 95 % confidence interval (CI) 1.81–2.86], tumor >2 cm (OR 2.14, 95 % CI 1.75–2.61), involved lymph nodes (OR 11.3, 95 % CI 9.29–13.6), hormone receptor-negative (OR 6.94, 95 % CI 4.89–9.86), Her2/neu-positive (OR 2.71, 95 % CI 2.10–3.51), or high grade (OR 3.53, 95 % CI 2.77–4.49) tumors; comorbidities associated inversely with chemotherapy use [heart disease for anthracyclines (OR 0.24, 95 % CI 0.14–0.41), neuropathy for taxanes (OR 0.45, 95 % CI 0.22–0.89)]. Relative to high-socioeconomic status (SES) non-Hispanic Whites, we observed less anthracycline and taxane use by SES non-Hispanic Whites (OR 0.63, 95 % CI 0.49-0.82) and American Indians (OR 0.23, 95 % CI 0.06–0.93), and more anthracycline use by high-SES Asians/Pacific Islanders (OR 1.72, 95 % CI 1.02–2.90). In this equal-access healthcare system, chemotherapy use followed practice guidelines, but varied by race and socio-demographic factors. These findings may inform efforts to optimize quality in breast cancer care. 相似文献
102.
Kwan ML Ambrosone CB Lee MM Barlow J Krathwohl SE Ergas IJ Ashley CH Bittner JR Darbinian J Stronach K Caan BJ Davis W Kutner SE Quesenberry CP Somkin CP Sternfeld B Wiencke JK Zheng S Kushi LH 《Cancer causes & control : CCC》2008,19(10):1065-1076
Objective With 2.3 million breast cancer survivors in the US today, identification of modifiable factors associated with breast cancer
recurrence and survival is increasingly important. Only recently new studies have been designed to examine the impact of lifestyle
factors on prognosis, including Pathways, a prospective study of women with breast cancer in Kaiser Permanente Northern California
(KPNC).
Methods Pathways aims to examine the effect on recurrence and survival of (1) lifestyle factors such as diet, physical activity, quality
of life, and use of alternative therapies and (2) molecular factors such as genetic polymorphisms involved in metabolism of
chemotherapeutic agents. Eligibility includes any woman diagnosed with invasive breast cancer within KPNC, no previous diagnosis
of other invasive cancer, age 21 years or older, and ability to speak English, Spanish, Cantonese, or Mandarin. Newly diagnosed
patients are identified daily from electronic pathology records and are enrolled within two months of diagnosis. An extensive
baseline interview is conducted, blood and saliva samples are collected, and body measurements are taken. Women are followed
for lifestyle updates, treatment, and outcomes by self-report and query of KPNC databases.
Results Recruitment began in 9 January, 2006, and as of 16 January, 2008, 1,539 women have been enrolled along with collection of
1,323 blood samples (86%) and 1,398 saliva samples (91%).
Conclusions The Pathways Study will become a rich resource to examine behavioral and molecular factors and breast cancer prognosis. 相似文献
103.
James F. Smith Bette J. Caan Barbara Sternfeld Reina Haque Charles P. Quesenberry Virginia P. Quinn Jun Shan Thomas J. Walsh Tom F. Lue Steven J. Jacobsen Stephen K. Van Den Eeden 《The journal of sexual medicine》2009,6(12):3433-3439
IntroductionThe burden of erectile dysfunction (ED) among different racial and ethnic groups is unclear, in part, because prior studies have not included all four major racial and ethnic groups in the same population‐based sample.AimTo determine the prevalence and odds of ED among all four major racial and ethnic groups after adjustment for demographic, medical, socioeconomic, and lifestyle characteristics.MethodsThis cross‐sectional study was conducted using data from men, aged 45–69 years, without a diagnosis of prostate cancer (N = 78,445), who completed questionnaires as part of the California Men's Health Study, a large multiethnic cohort study with detailed demographic, medical and, socioeconomic data.Main Outcome MeasureErectile dysfunction measured by a previously validated four‐level response question.ResultsThe overall prevalence of ED by age category was 13%, 24%, and 44% for men aged 45–49 years, 50 and 59 years, and 60–69 years, respectively. In a multivariable model, relative to white men, Hispanic (OR 1.05, 95% CI 0.99, 1.12), Asian (OR 1.1, 95% CI 1.02, 1.19), and other men (OR 1.13, 95% CI 1.06, 1.1.21) had increased odds of moderate‐severe ED, while black men were less likely to report moderate to severe ED (OR 0.86, 95% CI 0.81, 0.92). Black (OR 0.54, 95% CI 0.48, 0.61) and Asian men (OR 0.91, 95% CI 0.80, 1.04) were less likely to have severe ED after adjustment for age, socioeconomic status, medical co‐morbidities, and lifestyle characteristics.ConclusionThese data demonstrate that the prevalence of ED among different racial and ethnic groups is likely the result of complex phenomena and depends upon the interplay of socioeconomic, demographic, medical, cultural, and lifestyle characteristics. After accounting for these factors, these data suggest that Asian and black men are less likely to have severe ED relative to white men. Smith JF, Caan BJ, Sternfeld B, Haque R, Quesenberry CP, Jr, Quinn VP, Shan J, Walsh TJ, Lue TF, Jacobsen SJ, and Van Den Eeden SK. Racial disparities in erectile dysfunction among participants in the California men's health study. 相似文献
104.
Nechuta SJ Caan BJ Chen WY Flatt SW Lu W Patterson RE Poole EM Kwan ML Chen Z Weltzien E Pierce JP Shu XO 《Cancer causes & control : CCC》2011,22(9):1319-1331
The After Breast Cancer Pooling Project was established to examine the role of physical activity, adiposity, dietary factors, supplement use, and quality of life (QOL) in breast cancer prognosis. This paper presents pooled and harmonized data on post-diagnosis lifestyle factors, clinical prognostic factors, and breast cancer outcomes from four prospective cohorts of breast cancer survivors (three US-based and one from Shanghai, China) for 18,314 invasive breast cancer cases diagnosed between 1976 and 2006. Most participants were diagnosed with stage I-II breast cancer (84.7%). About 60% of breast tumors were estrogen receptor (ER)+/progesterone receptor (PR)+; 21% were ER-/PR-. Among 8,118 participants with information on HER-2 tumor status, 74.8% were HER-2- and 18.5% were HER-2+. At 1-2 years post-diagnosis (on average), 17.9% of participants were obese (BMI ≥ 30 kg/m2), 32.6% were overweight (BMI 25-29 kg/m2), and 59.9% met the 2008 Physical Activity Guidelines for Americans (≥ 2.5 h per week of moderate activity). During follow-up (mean = 8.4 years), 3,736 deaths (2,614 from breast cancer) and 3,564 recurrences have been documented. After accounting for differences in year of diagnosis and timing of post-diagnosis enrollment, five-year overall survival estimates were similar across cohorts. This pooling project of 18,000 breast cancer survivors enables the evaluation of associations of post-diagnosis lifestyle factors, QOL, and breast cancer outcomes with an adequate sample size for investigation of heterogeneity by hormone receptor status and other clinical predictors. The project sets the stage for international collaborations for the investigation of modifiable predictors for breast cancer outcomes. 相似文献
105.
Tetralogy of Fallot: MR findings 总被引:2,自引:0,他引:2
Surgical treatment of patients with tetralogy of Fallot requires accurate definition of all anatomic structures, particularly the central pulmonary arteries. Magnetic resonance (MR) images of 22 patients with tetralogy of Fallot were studied to assess their usefulness in providing information regarding the spectrum of anatomic abnormalities in this condition. MR findings were compared with information obtained at catheterization (in 16 patients) and at surgery (in nine patients), both of which were performed within 3 months of MR imaging. Ventricular chamber enlargement and wall hypertrophy were clearly delineated in most of the 17 patients who were examined before definitive surgical repair, and ventricular septal defects were visualized in all 17. Palliative systemic-to-pulmonary shunts were visualized in 11 patients and could be evaluated for patency. Most important, the morphology and size of the right ventricular outflow tract and central pulmonary arteries could be accurately assessed. Pulmonary artery measurements obtained from MR images demonstrated excellent correlation with angiographic measurements. In six patients examined after complete surgical repair, MR images accurately reflected changes in pulmonary artery outflow tract morphology and complications, such as residual pulmonary artery stenosis and thrombosis. The findings suggest that MR imaging can complement or obviate catheterization in the evaluation of tetralogy of Fallot with regard to suitability for definitive surgical repair. 相似文献
106.
107.
108.
Cardiometabolic risk factors and survival after breast cancer in the Women's Health Initiative
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Michael S. Simon MD MPH Jennifer L. Beebe‐Dimmer PhD Theresa A. Hastert PhD JoAnn E. Manson MD DrPH Elizabeth M. Cespedes Feliciano ScD Marian L. Neuhouser PhD RD Gloria Y. F. Ho PhD Jo L. Freudenheim PhD Howard Strickler MD Julie Ruterbusch MPH Ana Barac MD PhD Rowan Chlebowski MD PhD Bette Caan DrPH 《Cancer》2018,124(8):1798-1807
109.
110.
MT Britto JM Garrett MA Dugliss CW Daeschner CA Johnson MW Leigh JM Majure WH Schultz TR Konrad 《Pediatrics》1998,101(2):250-256
OBJECTIVE: To determine the prevalence and age of onset of common risky behaviors such as smoking and sexual activity in teens with cystic fibrosis and those with sickle cell disease and to compare their behaviors with those of adolescents in the general population. DESIGN: Survey. SETTING: All five major pediatric tertiary care centers in North Carolina (study participants with sickle cell disease or cystic fibrosis) and North Carolina public schools (comparison population). PARTICIPANTS: Three hundred twenty-one adolescents with cystic fibrosis or sickle cell disease aged 12 to 19 years (mean age, 15.6 years; 49% female). Demographically matched comparison teens for each group were selected from 2760 in-school adolescents (mean age, 16.0 years; 51% female). MAIN OUTCOMES MEASURES: Prevalence of tobacco and marijuana use, alcohol use, sexual intercourse, sexually transmitted diseases, seat belt use, weapon carrying, and age of onset of these behaviors. RESULTS: Chronically ill teens reported significantly less lifetime and current use of tobacco, marijuana, and alcohol; less sexual intercourse; less weapon carrying, less drunk driving, and more seat belt use than their peers. Nonetheless, 21% of the teens with cystic fibrosis and 30% of those with sickle cell disease had smoked; sexual intercourse was reported by 28% and 51%, respectively. Age of onset of these behaviors was frequently older for the chronically ill teens. CONCLUSION: Teens with cystic fibrosis or sickle cell disease took more potentially damaging health risks than might be expected, although the prevalence was lower than reported by their peers. Future longitudinal studies should examine the relationships between chronic illness, physical and psychosocial maturation, and risky behavior. Screening for psychosocial issues, including risky behaviors, should be incorporated into the routine health care of chronically ill teens. 相似文献