Achieving Health Equity in Colorectal Cancer: A Call to Action

2013 ◽  
pp. 169-173
Author(s):  
Toni M. Cipriano ◽  
Blase N. Polite
Keyword(s):  
Colon Cancer ◽  
Health Disparities ◽  
Lifestyle Changes ◽  
Call To Action ◽  
Appropriate Treatment ◽  
Timely Fashion ◽  
Cancer Specific Mortality ◽  
Race Ethnicity ◽  
To Receive

Whether defined by race, ethnicity, or socioeconomic status, there are clear health disparities in colon cancer—disparities that exist whether you measure screening, incidence, or mortality. Rather than rehash disparity statistics, the purpose of this educational article is to highlight important resources and how they can be used to help narrow these disparities. Although the logistics can be complex, the general solutions to eliminating colon cancer health disparities are not complex. They are as follows: Asymptomatic persons need to be screened. After being screened, they need to be diagnosed. After being diagnosed, they need to receive appropriate treatment in a timely fashion. After receiving treatment, they have to receive appropriate follow-up and information and advice on lifestyle changes. If we can implement these measures, then cancer-specific mortality disparities will be dramatically reduced, if not eliminated.

scholarly journals Reversal of Prediabetes in Saudi Adults: Results from an 18 Month Lifestyle Intervention

Nutrients ◽  
2020 ◽  
Vol 12 (3) ◽  
pp. 804 ◽  
Author(s):  
Osama E. Amer ◽  
Shaun Sabico ◽  
Hanan A. Alfawaz ◽  
Naji Aljohani ◽  
Syed Danish Hussain ◽  
...  
Keyword(s):  
Lifestyle Intervention ◽  
Lifestyle Modification ◽  
Multicenter Trial ◽  
Lifestyle Changes ◽  
Control Group ◽  
Post Intervention ◽  
Exercise Behaviors ◽  
Diet And Exercise ◽  
To Receive

Aim: This 18 month intervention study aims to determine the efficacy of a lifestyle modification program on prediabetes reversal among Saudi adults. Methods: An 18 month randomized, multicenter trial was conducted among Saudis with prediabetes aged 25–60 recruited from King Salman Hospital and primary care centers in Riyadh, Saudi Arabia. A total of 180 consenting individuals were randomized (1:1) to receive either intensive lifestyle intervention (ILIG) or guidance (control group, CG). ILIG was provided with a personalized lifestyle counseling by nutritionists every 3 months to improve diet and exercise behaviors. CG was given booklets containing information on prediabetes and its prevention. Data from lifestyle assessments and laboratory measurements were analyzed at baseline and every 6 months. The primary outcome was the reversal rate of prediabetes. Results: 158 participants were analyzed (CG:85, ILIG:73) at the 12 month follow-up and 28 participants (CG:11 and ILIG:17) completed the entire 18 month study. Post-intervention, the cumulative incidence of prediabetes reversal in the ILIG was 38 participants (52.1%) which was significantly higher than CG with 26 participants (30.6%) (p = 0.02). Conclusion: A tailored lifestyle intervention is effective in reversing prediabetes, at least for a year, among Arab adults with prediabetes. The challenge of sustaining interest in adopting lifestyle changes for a longer duration should be addressed in this population.

Prospectively randomized trial of postoperative adjuvant chemotherapy in patients with high-risk colon cancer.

1998 ◽  
Vol 16 (1) ◽  
pp. 295-300 ◽  
Author(s):  
M J O'Connell ◽  
J A Laurie ◽  
M Kahn ◽  
R J Fitzgibbons ◽  
C Erlichman ◽  
...  
Keyword(s):  
Colon Cancer ◽  
High Risk ◽  
Adjuvant Chemotherapy ◽  
Patient Survival ◽  
Postoperative Adjuvant Chemotherapy ◽  
Standard Regimen ◽  
Treatment Groups ◽  
Intensive Course ◽  
To Receive

PURPOSE This study had two major goals: (1) to assess the effectiveness of a regimen of fluorouracil (5-FU) plus levamisole plus leucovorin as postoperative surgical adjuvant therapy for patients with high-risk colon cancer, and (2) to evaluate 6 months versus 12 months of chemotherapy. PATIENTS AND METHODS Patients with poor-prognosis stage II or III colon cancer were randomly assigned to receive adjuvant chemotherapy with either intensive-course 5-FU and leucovorin combined with levamisole, or a standard regimen of 5-FU plus levamisole. Patients were also randomly assigned to receive either 12 months or 6 months of chemotherapy, which resulted in four treatment groups. RESULTS Eight hundred ninety-one of 915 patients entered (97.4%) were eligible. The median follow-up duration is 5.1 years for patients still alive. There was a difference among the four treatment groups with respect to patient survival, and a significant duration-by-regimen interaction was observed. Specifically, standard 5-FU plus levamisole was inferior to 5-FU plus leucovorin plus levamisole when treatment was given for 6 months (5-year survival rate, 60% v 70%; P < .01). CONCLUSION There was no significant improvement in patient survival when chemotherapy was given for 12 months compared with 6 months. When chemotherapy was given for 6 months, standard 5-FU plus levamisole was associated with inferior patient survival compared with intensive-course 5-FU plus leucovorin plus levamisole. These data suggest that 5-FU plus levamisole for 6 months should not be used in clinical practice, whereas 6 months of treatment with 5-FU plus leucovorin plus levamisole is effective.

Oxaliplatin/5FU/LV in adjuvant colon cancer: Updated efficacy results of the MOSAIC trial, including survival, with a median follow-up of six years

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 4007-4007 ◽  
Author(s):  
A. de Gramont ◽  
C. Boni ◽  
M. Navarro ◽  
J. Tabernero ◽  
T. Hickish ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Disease Free Survival ◽  
Significant Benefit ◽  
Stage Ii ◽  
Free Survival ◽  
Resected Stage ◽  
To Receive ◽  
Disease Free

4007 Background: The MOSAIC study was designed to evaluate the effects of the FOLFOX4 regimen (5-FU/LV + oxaliplatin) on 3- year disease free survival (DFS) probability in patients with stage II and III colon cancer. Methods: Patients (n=2246) with completely resected stage II (40%) or III (60%) colon cancer were randomly assigned to receive 5-FU/LV (LV5FU2) or FOLFOX4 every 2 weeks for 12 cycles. Results: Results for the primary endpoint of the study (for the overall population, with a median follow-up [FU] of 3 years), showed a significant benefit in DFS for the FOLFOX4-treated patients (78.2% vs 72.9%; HR: 0.77, p=0.002) (André et al, NEJM, 2004). Patients were followed beyond the 3-year cut-off for DFS and overall survival (OS) updates. Final DFS, at 5 years FU, are consistent with earlier results (HR: 0.80, p = 0.003). In addition, at a median FU of 6 years, the study demonstrates a significant benefit in OS for the stage III patients. Summary of OS results (median FU 6 years) Long-term safety update shows no increase in the rate of secondary cancer (5.0% in both treatment arms). Conclusions: These results confirm the benefit of the FOLFOX4 regimen in adjuvant colon cancer patients. [Table: see text] No significant financial relationships to disclose.

scholarly journals Contraindicated Use of Bevacizumab and Toxicity in Elderly Patients With Cancer

2013 ◽  
Vol 31 (28) ◽  
pp. 3592-3599 ◽  
Author(s):  
Dawn L. Hershman ◽  
Jason D. Wright ◽  
Emerson Lim ◽  
Donna L. Buono ◽  
Wei Yann Tsai ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Metastatic Breast ◽  
Tumor Type ◽  
Lower Socioeconomic Status ◽  
Patients With Cancer ◽  
Lower Socioeconomic ◽  
Black Patients ◽  
Medicare Database ◽  
To Receive

Purpose Drugs are approved on the basis of randomized trials conducted in selected populations. However, once approved, these treatments are usually expanded to patients ineligible for the trial. Patients and Methods We used the SEER-Medicare database to identify subjects older than 65 years with metastatic breast, lung, and colon cancer, diagnosed between 2004 and 2007 and undergoing follow-up to 2009, who received bevacizumab. We defined a contraindication as having at least two billing claims before bevacizumab for thrombosis, cardiac disease, stroke, hemorrhage, hemoptysis, or GI perforation. We defined toxicity as first development of one of these conditions after therapy. Results Among 16,085 metastatic patients identified, 3,039 (18.9%) received bevacizumab. Receipt of bevacizumab was associated with white race, later year of diagnosis, tumor type, and decreased comorbid conditions. Of patients who received bevacizumab, 1,082 (35.5%) had a contraindication. In multivariate analysis, receipt of bevacizumab with a contraindication was associated with black race (odds ratio [OR] = 2.6; 95% CI, 1.4 to 4.9), increased age, comorbidity, later year of diagnosis, and lower socioeconomic status. Patients with lung (OR = 1.7; 95% CI, 1.1 to 2.4) and colon cancer (OR = 1.4; 95% CI, 1.1 to 1.9) were more likely to have a contraindication. In the group with no contraindication, 30% had a complication after bevacizumab; black patients were more likely to have a complication than were white patients (OR = 1.9; 95% CI, 1.21 to 2.93). Conclusion Our study demonstrates widespread use of bevacizumab among patients who had contraindications. Black patients were less likely to receive the drug, but those who did were more likely to have a contraindication. Efforts to understand toxicity and efficacy in populations excluded from clinical trials are needed.

scholarly journals EXPRESS: Health disparities and treatment approaches in portopulmonary hypertension and idiopathic pulmonary arterial hypertension: An analysis of the Pulmonary Hypertension Association Registry

2021 ◽  
pp. 204589402110209
Author(s):  
Hilary Megan DuBrock ◽  
Charles D. Burger ◽  
Sonja Bartolome ◽  
Jeremy Feldman ◽  
David D Ivy ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Health Disparities ◽  
Pulmonary Arterial Hypertension ◽  
Idiopathic Pulmonary Arterial Hypertension ◽  
Portopulmonary Hypertension ◽  
Similar Treatment ◽  
Pulmonary Arterial ◽  
Ed Visits ◽  
To Receive

Compared to idiopathic pulmonary arterial hypertension (IPAH), patients with portopulmonary hypertension (POPH) have worse survival. Health disparities may contribute to these differences but have not been studied. We sought to compare socioeconomic factors in patients with POPH and IPAH and to determine whether socioeconomic status (SES) and/or POPH diagnosis were associated with treatment and healthcare utilization. We performed a cross-sectional study of adults enrolled in the Pulmonary Hypertension Association Registry. Patients with IPAH (n=344) and POPH (n=57) were compared. Compared with IPAH, patients with POPH were less likely to be college graduates (19.6 versus 34.9%, p=0.02) and more likely to be unemployed (54.7 versus 30.5%, p<0.001) and have an annual household income below poverty level (45.7 versus 19.0%, p<0.001). Patients with POPH had similar functional class, quality of life, 6MWD and mean pulmonary arterial pressure with a higher cardiac index. Compared with IPAH, patients with POPH were less likely to receive combination therapy (46.4 versus 62.2%, p=0.03) and endothelin receptor antagonists (ERAs) (28.6 versus 55.1%, p<0.001) at enrollment with similar treatment at follow-up. Patients with POPH had more emergency department (ED) visits (1.7±2.1 versus 0.9±1.2, p=0.009) and hospitalizations in the 6 months preceding enrollment (1.5±2.1 versus 0.8±1.1, p=0.02). Both POPH diagnosis and lower education level were independently associated with a higher number of ED visits. Compared to IPAH, patients with POPH have lower SES, are less likely to receive initial combination therapy and ERAs but have similar treatment at follow-up and have increased healthcare utilization.

Circulating tumor DNA-based decision for adjuvant treatment in colon cancer stage II evaluation: (CIRCULATE-trial) AIO-KRK-0217.

2020 ◽  
Vol 38 (4_suppl) ◽  
pp. TPS273-TPS273
Author(s):  
Gunnar Folprecht ◽  
Anke Reinacher-Schick ◽  
Andrea Tannapfel ◽  
Juergen Weitz ◽  
Thibaud Kossler ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Adjuvant Chemotherapy ◽  
Disease Free Survival ◽  
Circulating Tumor Dna ◽  
Stage Ii ◽  
Patient Specific ◽  
Cancer Stage ◽  
To Receive ◽  
Colon Cancer Stage Ii

TPS273 Background: The benefit of adjuvant chemotherapy in stage II colon cancer is unclear, and clear clinical or molecular marker are not available for decision making. Recently, postoperative circulating tumour (ct)DNA has been demonstrated to be prognostic in colorectal cancer and other tumours. Methods: For the CIRCULATE trial we enrol patients (pts) with colon cancer stage II in Germany (AIO), Austria (ABCSG) and Switzerland (SAKK). Microsatellite stable pts are screened after resection of the primary by analysing the tumour block with panel sequencing and measuring patient specific mutations in the postoperative plasma sample. MSI-H pts are excluded from the trial. ctDNA positive (ctDNApos) pts are randomised (2:1) to receive adjuvant capecitabine based chemotherapy or no chemotherapy. Oxaliplatin can be added according to investigator’s choice. ctDNA negative (ctDNAneg) pts are randomised (1:4) to be followed-up within the study or to receive standard follow-up outside the trial. Pts in the follow-up group and their investigators are blinded for the ctDNA result. The primary aim is to compare the disease free survival (DFS) in ctDNApos pts randomised to chemotherapy or to follow-up. Secondary aims are to compare the overall survival (OS) in ctDNApos pts with or without chemo, to compare the DFS and OS in ctDNApos vs. ctDNAneg follow-up pts, to describe the DFS and OS in ctDNAneg pts, to describe the location of recurrences/metastases according ctDNA status, the ctDNA clearance rate and time to ctDNA negativity during adjuvant chemotherapy, further translational endpoints, and safety. To demonstrate a treatment effect in the ctDNA group with a hazard ratio of 0.617 (3 year DFS rate of 42.5 % vs. 25 %), 231 ctDNApos will be randomised (approx. 2310 pts in total) from 2019 – 2022. Clinical trial information: NCT04089631.

Adjuvant active specific immunotherapy for human colorectal cancer: 6.5-year median follow-up of a phase III prospectively randomized trial.

1993 ◽  
Vol 11 (3) ◽  
pp. 390-399 ◽  
Author(s):  
H C Hoover ◽  
J S Brandhorst ◽  
L C Peters ◽  
M G Surdyke ◽  
Y Takeshita ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Colon Cancer ◽  
Cancer Patients ◽  
Specific Immunotherapy ◽  
Disease Free Survival ◽  
Free Survival ◽  
Active Specific Immunotherapy ◽  
To Receive ◽  
Disease Free

PURPOSE Patients with colon or rectal cancer were entered onto a prospectively randomized, controlled clinical trial of active specific immunotherapy (ASI) with an autologous tumor cell-bacillus Calmette-Guérin (BCG) vaccine. We investigated whether ASI could improve disease-free status and survival. PATIENTS AND METHODS Ninety-eight patients with Dukes' stage B2-C3 colon or rectal cancer were randomized into groups treated by resection alone or resection plus ASI. Eighty patients met all eligibility criteria. All patients with rectal cancer were to receive 50 Gy of pelvic irradiation. Analysis of distribution of survival and disease-free survival was made on all eligible patients until December 31, 1990. RESULTS As a single study, no statistically significant differences were detected in survival or disease-free survival for all 80 eligible patients. However, since it was recognized at the outset that there were treatment differences, in that rectal cancer patients were to receive postimmunotherapy radiation, it was considered that a cohort analysis of the colon and rectal cancer patients might be informative. With a median follow-up of 93 months, there is a significant improvement in survival (two-sided P = .02; hazards ratio, 3.97) and disease-free survival (two-sided P = .039; hazards ratio, 2.67) in all eligible colon cancer patients who received ASI. With a median follow-up of 58 months, no benefits were seen in patients with rectal cancer who received ASI. CONCLUSION This study suggests that ASI may be beneficial to patients with colon cancer.

Controlled trial of fluorouracil and low-dose leucovorin given for 6 months as postoperative adjuvant therapy for colon cancer.

1997 ◽  
Vol 15 (1) ◽  
pp. 246-250 ◽  
Author(s):  
M J O'Connell ◽  
J A Mailliard ◽  
M J Kahn ◽  
J S Macdonald ◽  
D G Haller ◽  
...  
Keyword(s):  
Colon Cancer ◽  
High Risk ◽  
Low Dose ◽  
Controlled Trial ◽  
Stage Iii Colon Cancer ◽  
Tumor Relapse ◽  
Time To Relapse ◽  
Intensive Course ◽  
To Receive

PURPOSE The goal of this study was to determine the efficacy of intensive-course fluorouracil (5FU) plus low-dose leucovorin given for 6 months following potentially curative resection of colon cancer. PATIENTS AND METHODS Three hundred seventeen patients with high-risk stage II or stage III colon cancer were randomly assigned 3 to 4 weeks following surgery to receive either (1) chemotherapy with six cycles of 5FU (425 mg/m2) plus leucovorin (20 mg/m2) by rapid intravenous injection daily for 5 consecutive days every 4 to 5 weeks, or (2) observation. RESULTS The median follow-up duration is 72 months for patients still alive. Patients who received postoperative 5FU plus leucovorin experienced significant improvement in time to relapse (P < .01) and survival (P = .02) compared with control patients treated with surgery alone. Stomatitis, diarrhea, and leukopenia were the predominant chemotherapy toxicities. There were no treatment-related deaths. CONCLUSION These results indicate that intensive-course 5FU plus low-dose leucovorin is effective in preventing tumor relapse and improving survival in patients with high-risk colon cancer. These benefits were seen with only six cycles of treatment, using low-dose leucovorin in combination with 5FU on a schedule convenient for outpatient administration.

scholarly journals Six Month Safety and Efficacy of the BNT162b2 mRNA COVID-19 Vaccine

2021 ◽  
Author(s):  
Stephen J Thomas ◽  
Edson D Moreira ◽  
Nicholas Kitchin ◽  
Judith Absalon ◽  
Alejandra Gurtman ◽  
...  
Keyword(s):  
Vaccine Efficacy ◽  
Severe Disease ◽  
Safety Data ◽  
Efficacy Study ◽  
Post Vaccination ◽  
Race Ethnicity ◽  
Favorable Safety ◽  
To Receive ◽  
Rna Vaccine

Background: BNT162b2 is a lipid nanoparticle-formulated, nucleoside-modified RNA vaccine encoding a prefusion-stabilized, membrane-anchored SARS-CoV-2 full-length spike protein. BNT162b2 is highly efficacious against COVID-19 and is currently authorized for emergency use or conditional approval worldwide. At the time of authorization, data beyond 2 months post-vaccination were unavailable. Methods: In an ongoing, placebo-controlled, observer-blinded, multinational, pivotal efficacy study, 44,165 ≥16-year-old participants and 2,264 12-15-year-old participants were randomized to receive 2 doses, 21 days apart, of 30 μg BNT162b2 or placebo. Study endpoints reported here are vaccine efficacy (VE) against laboratory-confirmed COVID-19 and safety data, both up to 6 months post-vaccination. Results: BNT162b2 continued to be safe and well tolerated. Few participants had adverse events leading to study withdrawal. VE against COVID-19 was 91% (95% CI 89.0‒93.2) through up to 6 months of follow-up, among evaluable participants and irrespective of previous SARS-CoV-2 infection. VE of 86%‒100% was seen across countries and in populations with diverse characteristics of age, sex, race/ethnicity, and COVID-19 risk factors in participants without evidence of previous SARS-CoV-2 infection. VE against severe disease was 97% % (95% CI 80.3‒99.9). In South Africa, where the SARS-CoV-2 variant of concern, B.1.351 (beta), was predominant, 100% (95% CI 53.5, 100.0) VE was observed. Conclusion: With up to 6 months of follow-up and despite a gradually declining trend in vaccine efficacy, BNT162b2 had a favorable safety profile and was highly efficacious in preventing COVID-19. (ClinicalTrials.gov number, NCT04368728)

Diminishing Barriers to the Praxis Examination in Communication Sciences and Disorders

2011 ◽  
Vol 1 (2) ◽  
pp. 64-71
Author(s):  
Luis F. Riquelme
Keyword(s):  
Geographic Location ◽  
The United States ◽  
Success For All ◽  
Speech Language Pathology ◽  
Barriers To Success ◽  
Call To Action ◽  
Language Pathology ◽  
National Certification ◽  
Race Ethnicity ◽  
Passing Score

Abstract Passing the Praxis Examination in speech-language pathology or audiology can be a difficult task. A passing score is the entry to a list of requirements for national certification (CCC-SLP, CCC-A) and for state licensure in the United States. This article will provide current information on the examination and address barriers to success that have been identified over the years. A call to action may serve to refocus efforts on improving access to success for all test-takers regardless of race/ethnicity, ability, or geographic location.

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