The demand for psycho-oncological support in 820 melanoma patients: What are the determinants for the development of distress?

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 9514-9514
Author(s):  
Andrea Forschner ◽  
Petra Riedel ◽  
Maximilian Gassenmaier ◽  
Alexander Scheu ◽  
Lukas Kofler ◽  
...  
Keyword(s):  
Lower Risk ◽  
Systemic Treatment ◽  
Female Gender ◽  
Advanced Melanoma ◽  
Stage Iii ◽  
Patient Specific ◽  
Psychological Burden ◽  
Younger Age ◽  
Melanoma Patients ◽  
The Impact

9514 Background: There is limited data about the impact of melanoma on the psychological burden of patients. Despite some known predictors for distress like female gender or younger age, melanoma stages have not been found being related to distress in melanoma patients and there is no data concerning distress in melanoma patients under systemic treatment for metastases. Methods: Between July and September 2016, 820 melanoma patients at the outpatient clinic at the Department of Dermatology at the University of Tuebingen underwent psycho-oncological screening. The patients routinely completed the distress thermometer (DT), supplemented by a problem list, before consulting the physician. DT scores ≥ 5 are above-threshold, indicating the need for psycho-oncological support. We matched psycho-oncological data with tumor and patient specific data to examine tumor or patient specific influence on distress using logistic regression. Results: 406 (49.5%) men and 414 (50.5%) women were included, mean age was 62.35 years (IQR 52-75), mean time since primary diagnosis of melanoma was 54.84 months (IQR 15-76). 359 (44%) of the patients suffered from advanced melanoma (stage III n = 182, stage IV n = 177). 120 patients (14.6%) received systemic treatment for metastases: 90/120 (75%) checkpoint inhibitors, 27/120 (22.5%) targeted therapy and 3/120 (2.5%) chemotherapy. 338/820 (41.2%) of the patients met the cut-off score for distress. Significant influencing factors (p < 0.05) for DT values of ≥ 5 were: female gender, younger age, melanoma stage III and IV. Interestingly we found a lower risk for values above-threshold for patients under systemic treatment, although this was not significant (p = 0.252). Conclusions: This is the first analysis to demonstrate the impact of advanced melanoma stages on DT scores above-threshold. Our study is also the first to indicate a lower risk for distress in patients under systemic treatment. This might be due to the closer contact between these patients and their physicians. Nevertheless, more than 40% of our patients needed psycho-oncological support. Departments that care for melanoma patients should therefore be fitted by a sufficient number of psycho-oncologists.

Stress, anxiety, depression and burnout in frontline health care workers during COVID-19 pandemic: a brief systematic review and new data from Russia

2021 ◽  
Author(s):  
Ekaterina Mosolova ◽  
Dmitry Sosin ◽  
Sergey Mosolov
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Female Gender ◽  
Assessment Tools ◽  
Care Workers ◽  
Younger Age ◽  
Wide Range ◽  
Associated Risk Factors ◽  
Anxiety Depression ◽  
The Impact

During the COVID-19 pandemic, healthcare workers (HCWs) have been subject to increased workload while also exposed to many psychosocial stressors. In a systematic review we analyze the impact that the pandemic has had on HCWs mental state and associated risk factors. Most studies reported high levels of depression and anxiety among HCWs worldwide, however, due to a wide range of assessment tools, cut-off scores, and number of frontline participants in the studies, results were difficult to compare. Our study is based on two online surveys of 2195 HCWs from different regions of Russia during spring and autumn epidemic outbreaks revealed the rates of anxiety, stress, depression, emotional exhaustion and depersonalization and perceived stress as 32.3%, 31.1%, 45.5%, 74.2%, 37.7% ,67.8%, respectively. Moreover, 2.4% of HCWs reported suicidal thoughts. The most common risk factors include: female gender, nurse as an occupation, younger age, working for over 6 months, chronic diseases, smoking, high working demands, lack of personal protective equipment, low salary, lack of social support, isolation from families, the fear of relatives getting infected. These results demonstrate the need for urgent supportive programs for HCWs fighting COVID-19 that fall into higher risk factors groups.

The solved and unresolved issues of melanoma staging: A comparison of American Joint Committee on Cancer (AJCC) 7th versus 8th edition.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 9578-9578
Author(s):  
Shirin Bajaj ◽  
Anthony Collado ◽  
Una Moran ◽  
Douglas MacArthur Donnelly ◽  
Paul Johannet ◽  
...  
Keyword(s):  
Cox Regression ◽  
Primary Melanoma ◽  
Progression Free Survival ◽  
Stage I ◽  
Added Value ◽  
Stage Iii ◽  
Melanoma Patients ◽  
Ajcc Staging ◽  
The Impact ◽  
8Th Edition

9578 Background: The recently revised (AJCC) Staging Manual, 8th edition, introduced changes including removal of mitotic index and addition of the IIID substage. There is active debate on the utility of this revision, especially, without the inclusion of a novel prognostic biomarker, during an era of major therapeutic shifts and amidst accrual of adjuvant clinical trials for high-risk resected primary melanoma. We examined whether re-staging primary melanoma patients using the new AJCC 8 system yielded improved prognostication as compared to AJCC 7. Methods: We compared the impact of changes in staging criteria in stage I-III melanoma patients who were prospectively enrolled in a NYU clinicopathological database between January 2010 and December 2016 with active protocol-driven follow up (FU). We assessed primary tumor category (T) and nodal status (N) according to both AJCC 7 and 8. Progression free survival (PFS) and overall survival (OS) curves were generated for both editions and then stratified by substage. We analyzed discordance using Cox Regression Models. Results: 1,379 patients (56% male, mean thickness 1.6, median FU 34.8 months) were included in the analyses. All but one patient remained in the same ‘major’ stage using AJCC 7 and 8 (stage I- 998; II- 224, 225; III- 157, 156) whereas 44% of stage III substage classifications were discordant comparing AJCC 7 to 8. Despite removing mitoses as a criterion for Stage I, there was no significant change between editions in PFS/OS when evaluating major and substages of stage I. Stage IIC patients had worse PFS/OS than stage IIIA patients in AJCC 8 (PFS p = 0.04, OS p = 0.02). AJCC 8, which implemented four rather than three substages, had improved PFS prognostication (c-index = 0.59 vs 0.66, p = 0.05 for AJCC 7 vs 8). Conclusions: Our results reinforce the added value of AJCC 8 compared to 7, as removing an operator dependent variable is more practical for stage I, and increased influence of thickness/ulceration and the addition of a new substage is more prognostically informative for stage III. Nevertheless, the poor prognosis of stage IIC patients, despite nodal negative disease, continues to be an unaddressed gap within our current staging framework.

scholarly journals SUN-620 Gender Difference in the Outcome of Patients with Diabetes Admitted for Hyperosmolar Hyperglycemia. from the National Inpatient Sample

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Fatima Ahmed ◽  
Ashraf Abugroun ◽  
Manar Elhassan ◽  
Berhane Seyoum
Keyword(s):  
Mechanical Ventilation ◽  
Length Of Stay ◽  
Lower Risk ◽  
Female Gender ◽  
Secondary Outcome ◽  
National Inpatient Sample ◽  
Patients With Diabetes ◽  
Hyperosmolar Hyperglycemic State ◽  
The Mean ◽  
The Impact

Abstract Objective: There is paucity of literature on the impact of gender on outcomes of hyperosmolar hyperglycemic state (HHS) among adult patients with diabetes. The aim of this study was to evaluate the effect of gender on the outcome of these patients. Methodology: The National Inpatient Sample (NIS) was queried for all patients who were admitted with a diagnosis of hyperosmolar hyperglycemic state (HHS) during the years 2005-2014. The primary outcomes of the study were all-cause mortality, acute myocardial infarction (MI), and acute stroke. The secondary outcomes were acute kidney injury (AKI), rhabdomyolysis, acute respiratory failure (ARF), need for mechanical ventilation (MV), length of stay (LOS), and total cost of stay. Results: Overall, 188,725 patients were admitted for HHS. Mean age of males was 53.7, standard error of the mean (SEM: 0.13), and of females was 58.5 (SEM: 0.15), p&lt;0.001. Females were (43.9%), Caucasians were 37.4% while African Americans were 35.2%. Total mortality was 1.1%, MI was 1.3% and stroke was 1.1%. Most common secondary outcome was AKI seen in 31.3% followed by ARF seen in 2.9% of total. The mean cost was 7887 $ (SEM: 84.6) and mean LOS was 4.1 days (SEM: 0.03). Both males and females had equivalent rates of mortality, stroke, ARF and need for mechanical ventilation. Compared to males, females had significantly higher risk for MI 1.6% vs 1.1%, p&lt;0.001, lower risk for AKI 29.3% vs 32.9%, p&lt;0.001, lower risk for rhabdomyolysis 1.1% vs 2%, p&lt;0.001 and higher LOS 4.3 vs 3.9 days, p&lt;0..01 and higher total costs 8165.6 $ vs 7669.3 $, p &lt; 0.001. On multivariable analysis, female gender was independently predictive for higher risk for MI with adjusted odds ratio (aOR) 1.34 [95%CI: 1.08-1.67] p=0.01 and lower risk for rhabdomyolysis with aOR 0.52 [95%CI: 0.42-0.63] p&lt;0.001 and lower risk for AKI with aOR 0.74 [95%CI: 0.7-0.78] p&lt;0.001. In addition, female gender correlated with higher cost and length of stay. Conclusion: Females with hyperosmolar hyperglycemic state are at higher risk for MI and lower risk for AKI and rhabdomyolysis.

scholarly journals Potential Reasons for Unresponsiveness to Anti-PD1 Immunotherapy in Young Patients with Advanced Melanoma

Life ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. 1318
Author(s):  
Devayani Machiraju ◽  
Sarah Schäfer ◽  
Jessica C. Hassel
Keyword(s):  
Overall Survival ◽  
Immune System ◽  
Treatment Approach ◽  
Young Patients ◽  
Treatment Strategies ◽  
Resistance Mechanisms ◽  
Advanced Melanoma ◽  
Age Dependent ◽  
Melanoma Patients ◽  
The Impact

The impact of age on the clinical benefit of anti-PD1 immunotherapy in advanced melanoma patients has been evolving recently. Due to a reduced immune function in elderly patients, young patients with a robust immune system are theoretically expected to benefit more from the treatment approach. However, in contrast to this hypothesis, recent studies in patients with metastatic melanoma have demonstrated that immunotherapy, especially with anti-PD1 treatment, is less effective in patients below 65 years, on average, with significantly lower responses and reduced overall survival compared to patients above 65 years of age. Besides, data on young patients are even more sparse. Hence, in this review, we will focus on age-dependent differences in the previously described resistance mechanisms to the treatment and discuss the development of potential combination treatment strategies for enhancing the anti-tumor efficacy of anti-PD1 or PDL1 treatment in young melanoma patients.

The prognostic role of preoperative serum lactate dehydrogenase (LDH) in patients with resected advanced melanoma.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e21054-e21054 ◽  
Author(s):  
Neil Majithia ◽  
Ana Velazquez Manana ◽  
Yiyi Yan ◽  
Lisa A. Kottschade ◽  
Roxana Stefania Dronca ◽  
...  
Keyword(s):  
Systemic Treatment ◽  
Stage Iv ◽  
Advanced Melanoma ◽  
Stage Iii ◽  
Adjuvant Radiation ◽  
Adjuvant Systemic Treatment ◽  
Upper Limit ◽  
Increased Risk

e21054 Background: Up to 50% of patients undergoing resection for advanced melanoma experience recurrence. Identification of preoperative prognostic biomarkers is needed to ascertain risk of relapse and guide postoperative management. Lactate dehydrogenase (LDH) represents a strong prognostic factor in unresectable metastatic (stage IV) melanoma, but its relevance in patients with resected stage III or IV disease remains unknown. Methods: We retrospectively analyzed data from patients with stage III and IV melanoma who had undergone complete resection of disease and received follow-up treatment at Mayo Clinic, Rochester between January 1, 2000 and January 31, 2012. Clinical data were collected from electronic records. Survival data were estimated using the Kaplan-Meier method. Associations of preoperative LDH with time to relapse and death were evaluated using Cox proportional hazards regression models and summarized with hazard ratios and 95% confidence intervals. Results: A total of 154 subjects with resectable stage III or IV melanoma were included in the study. Median age at the time of resection was 58; 54 (35.1%) were female. One-hundred sixteen (75.3%) patients were classified as stage III and 38 (24.7%) stage IV. Adjuvant systemic treatment was administered in 75 (48.7%) patients and adjuvant radiation in 32 (20.7%). Median duration of follow-up was 4.0 years. Sixteen (10.3%) patients had preoperative LDH above the upper limit of normal. Each 50-unit increase in LDH was associated with a 15% increased risk of relapse (HR 1.15; p = 0.040) and 23% increased risk of death (HR 1.23; p = 0.001). After adjusting for age, gender, stage, number of sites, adjuvant systemic treatment, and adjuvant radiation, preoperative LDH remained associated with time to death (HR 1.25; p = 0.002). Preoperative LDH greater than the upper limit of normal was associated with increased hazard of death, both with univariate (HR 2.44; p = 0.005) and multivariate (HR 2.17; p = 0.017) analyses. Conclusions: This study supports the role of elevated preoperative LDH as a predictor of inferior outcomes in patients with advanced melanoma. Further study to correlate LDH to outcomes in the era of adjuvant immunotherapy is required.

scholarly journals Association of NRAS Mutation With Clinical Outcomes of Anti-PD-1 Monotherapy in Advanced Melanoma: A Pooled Analysis of Four Asian Clinical Trials

2021 ◽  
Vol 12 ◽  
Author(s):  
Li Zhou ◽  
Xuan Wang ◽  
Zhihong Chi ◽  
Xinan Sheng ◽  
Yan Kong ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Cutaneous Melanoma ◽  
Progression Free Survival ◽  
Response Rates ◽  
Advanced Melanoma ◽  
Wild Type ◽  
Nras Mutation ◽  
Significant Difference ◽  
Melanoma Patients ◽  
The Impact

BackgroundAnti-PD-1 monotherapy is the standard therapy for advanced melanoma patients, including those with NRAS mutations. The influence of NRAS mutation on immunotherapy, especially in noncutaneous melanoma, is largely uncharacterized.Materials and MethodsWe analyzed clinical data of four clinical trials for advanced melanoma patients treated with anti-PD-1 monotherapy between 2016 and 2019. The impact of NRAS mutation on efficacy and outcome of immunotherapy were analyzed in cutaneous and noncutaneous groups separately.ResultsA total of 206 patients were assessed, including 92 cutaneous melanoma patients with 12 NRAS mutations and 114 noncutaneous melanoma patients with 21 NRAS mutations. In cutaneous melanoma, the response rates of NRAS mutant patients were lower than patients without NRAS mutations (9.5% vs. 23.9%), the median progression-free survival (PFS) and median overall survival (OS) were shorter for patients with NRAS mutations, although without significant difference for OS (P=0.081). In noncutaneous melanoma, the response rates were 0 and 13.7% for NRAS mutant and wild-type patients, the median PFS were 3.6 months (95% CI: 0.9-6.3) and 4.3 months (95%CI: 2.9-5.7) (P=0.015), and the median OS were 10.8 months (95% CI: 1.5-20.1) and 15.3 months (95% CI: 13.2-17.4) (P=0.025), respectively. In multivariate analysis, NRAS mutation, along with ECOG performance score and LDH level, was negatively associated with both PFS (HR 1.912, P=0.044) and OS (HR 2.210, P=0.025) in noncutaneous melanoma.ConclusionIn advanced Asian melanoma treated with anti-PD-1 monotherapy, NRAS mutant patients had lower response rates and poorer prognoses compared to wild-type patients, especially in noncutaneous subtypes.

scholarly journals The impact of mental health and substance use issues on COVID-19 vaccine readiness: a cross sectional community-based survey in Ontario, Canada

2021 ◽  
Author(s):  
Kamna Mehra ◽  
Roula Markoulakis ◽  
Sugy Kodeeswaran ◽  
Donald A. Redelmeier ◽  
Mark Sinyor ◽  
...  
Keyword(s):  
Mental Health ◽  
Social Support ◽  
Substance Use ◽  
Female Gender ◽  
Depression Score ◽  
Vaccine Hesitancy ◽  
Community Based ◽  
Cross Sectional ◽  
Younger Age ◽  
The Impact

AbstractBackgroundCOVID-19 vaccines have been approved for use in Canada since December 2020. However, data about factors associated with vaccine hesitancy and the impact of mental health and/or substance use (MHSU) issues on vaccine uptake are currently not available. The goal of this study was to explore factors, particularly MHSU factors, that impact COVID-19 vaccination intentions in Ontario, Canada.MethodsA community-based cross-sectional survey with recruitment based on age, gender, and geographical location (to ensure a representative population of Ontario), was conducted in February 2021. Multinomial logistic regression was used to test the relationship between COVID-19 vaccination status and plans and sociodemographic background, social support, anxiety about contracting COVID-19, and MHSU concerns.ResultsOf the total sample of 2528 respondents, 1932 (76.4%) were vaccine ready, 381 (15.1%) were hesitant, and 181 (7.1%) were resistant. Significant independent predictors of vaccine hesitancy compared with vaccine readiness included younger age (OR=2.11, 95%CI=1.62-2.74), female gender (OR=1.36, 95%CI=1.06-1.74), Black ethnicity (OR=2.11, 95%CI=1.19-3.75), lower education (OR=1.69, 95%CI=1.30-2.20), lower SES status (OR=.88, 95%CI=.84-.93), lower anxiety about self or someone close contracting COVID-19 (OR=2.06, 95%CI=1.50-2.82), and lower depression score (OR=.90, 95%CI=.82-.98). Significant independent predictors of vaccine resistance compared with readiness included younger age (OR=1.72, 95%CI=1.19-2.50), female gender (OR=1.57, 95%CI=1.10-2.24), being married (OR=1.50, 95%CI=1.04-2.16), lower SES (OR=.80, 95%CI=.74-.86), lower satisfaction with social support (OR=.78, 95%CI=.70-.88), lower anxiety about contracting COVID-19 (OR=7.51, 95%CI=5.18-10.91), and lower depression score (OR=.85, 95%CI=.76-.96).InterpretationCOVID-19 vaccination intention is affected by sociodemographic factors, anxiety about contracting COVID-19, and select mental health issues.

scholarly journals PTENP1-AS contributes to BRAF inhibitor resistance and is associated with adverse clinical outcome in stage III melanoma

2020 ◽  
Author(s):  
Linda Vidarsdottir ◽  
Alireza Azimi ◽  
Ingibjorg Sigvaldadottir ◽  
Aldwin Suryo Rahmanto ◽  
Andreas Petri ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Transcriptional Repression ◽  
Regional Lymph Node ◽  
Braf Inhibitor ◽  
Suppressor Gene ◽  
Stage Iii ◽  
Activating Mutations ◽  
Melanoma Patients ◽  
Stage Iii Melanoma ◽  
The Impact

ABSTRACTApproximately 50% of human cutaneous melanomas carry activating mutations in the serine/threonine protein kinase BRAF. BRAF inhibitors (BRAFi) selectively target the oncogenic BRAFV600E/K and are effective in approximately 80% of patients carrying the mutation. However, resistance to BRAFi is common and emerges within a median time of 6-7 months of treatment and is prolonged to 11 months when combined with MEK inhibitors. Better characterization of the underlying molecular processes is therefore needed to further improve treatments. Inactivation of the tumor suppressor gene PTEN has been suggested to occur during melanomagenesis and drug resistance development. We recently demonstrated that transcription of PTEN is negatively regulated by an antisense RNA from the PTEN pseudogene (PTENP1-AS) and here set out to investigate the impact of this molecular pathway on the resistance to BRAFi and clinical outcome. We used a panel of BRAFi resistant A375 sublines, and observed increased levels of PTENP1-AS associated with reduced expression of PTEN. Furthermore, this loss of PTEN expression was correlated to increased recruitment of Enhancer of zeste homolog 2 (EZH2) and formation of the transcriptional repression mark H3K27me3 at the PTEN promoter in the resistant cells. We demonstrated that targeting of PTENP1-AS was able to re-activate the expression of PTEN and sensitize resistant melanoma cells to BRAFi. Finally, we showed that PTENP1-AS is a promising prognostic marker for clinical outcome in melanoma patients as high expression of PTENP1-AS in regional lymph node metastases from stage III melanoma patients correlated with poor survival.

scholarly journals Health care disparities among octogenarians and nonagenarians with stage III lung cancer.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e18075-e18075 ◽  
Author(s):  
Richard John Cassidy ◽  
Xinyan Zhang ◽  
Pretesh R Patel ◽  
Joseph W Shelton ◽  
Sibo Tian ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Multivariable Analysis ◽  
Female Gender ◽  
Stage Iiib ◽  
Stage Iii ◽  
Black Race ◽  
Cancer Data ◽  
Anti Cancer ◽  
Stage Iii Nsclc ◽  
The Impact

e18075 Background: Octogenarians and nonagenarians with stage III lung cancer are underrepresented in randomized trials that established the standard of care therapy of concurrent chemoradiation (CRT). The purpose of this study was to investigate factors predictive of and the impact on overall survival (OS) following CRT among patients ≥80 years old with stage III non-small cell lung cancer (NSCLC) in the National Cancer Data Base (NCDB). Methods: In the NCDB, patients ≥80 years old from 2004 to 2013 with stage III NSCLC were queried. Logistic regression, Kaplan-Meier method, and Cox-proportional hazard regression analyses were performed as well as propensity-score matched (PSM) analysis to reduce treatment selection bias. Results: A total of 12,641 stage III NSCLC patients ≥80 years old were identified with complete treatment and OS records; 7,921 (62.7%) received no treatment, 1,153 received definitive radiation alone (9.1%), and 3,567 (28.2%) received CRT. On multivariable analysis (MVA), black race, female gender, advancing age, residence in a lower-educated county, adenocarcinoma histology, and patients with stage IIIB tumors were associated with receiving no anti-cancer therapy while treatment at an academic facility and lower comorbidity status were associated with receiving anti-cancer treatment (all p < 0.05). On MVA, male gender, advancing age, non-adenocarcinoma histology, higher tumor grade, larger tumors, advancing T and N stage, stage IIIB tumors (vs. IIIA), delayed start to CRT, and not receiving CRT were associated with worse OS (all p < 0.05). OS rates at 1 and 5 years was 53.7% and 10.1% respectively for patients receiving CRT compared to 16.4% and 3.3% respectively for all other therapies (p < 0.01). PSM analysis confirmed that not receiving CRT was associated with worse OS (HR = 1.23, 95% CI 1.11-1.34; p < 0.01). Conclusions: A significant portion of patients ≥80 years old with stage III NSCLC do not receive treatment. Black race, female gender, advancing age, and residence in a lower-educated county were associated with not receiving therapy. In this NCDB series, OS is higher in patients ≥80 years old receiving CRT, even when adjusting for patient- and tumor-related factors.

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