scholarly journals Return to Work in the Gastric Cancer Survivors

Author(s):  
Yuan-Yuei Chen ◽  
Wei-Liang Chen ◽  
Wei-Te Wu ◽  
Ching-Liang Ho ◽  
Chung-Ching Wang

Abstract Returning to work (RTW) is an often used outcome in work research to describe employee fully recovering from disease. Several factors are suggested as barriers for workers returning to work. The goal of this study was to investigate the role of RTW in workers with gastric cancer and identify its impact on their survival outcomes during 11 years of follow-up. A total of 4467 workers who with newly diagnosis of gastric cancer were included in this retrospective cohort study with a follow-up period ranging from 2004 to 2015. Relationships between work, treatment, and disease-related variables and RTW were analyzed by Cox regression. The impact of RTW on survival outcomes was analyzed by Kaplan-Meier survival curves. Old age, males, comorbidities, chemotherapy, radiotherapy, and manual jobs were inversely associated with RTW. Operation and early stage of gastric cancer were associated with increased likelihood of RTW. After adjusting for variables, workers with stage 1 gastric cancer were more likely return to work than other stages with HR of 4.67 (95%CI: 2.99~7.31) and 7.44 (95%CI: 4.12~13.43) in the 2nd and 5th year. In terms of effect of RTW on survival rate, reemployed workers had better survival than those without employment in all gastric cancer survivors. Furthermore, RTW had significant association with reduced risk of all-cause mortality (HR: 0.49, 95%CI: 0.38~0.65). Improving these identified barriers and strengthening facilitators of RTW can provide employers and government to conduct comprehensive employment plans for increasing the percentage of RTW in the gastric cancer survivors.

Author(s):  
Yu-Shan Sun ◽  
Wei-Liang Chen ◽  
Wei-Te Wu ◽  
Chung-Ching Wang

The aim of the current cohort study was to explore the relationship between return to work (RTW) after cervical cancer treatment and different medical and occupational covariates. We also investigated the effect of RTW on all-cause mortality and survival outcomes of cervical cancer survivors. Data were collected between 2004 and 2015 from the database of the Taiwan Cancer Registry, Labor Insurance Database, and National Health Insurance Research Database. The associations between independent variables and RTW were analyzed by Cox proportional hazard models. A total of 4945 workers (82.3%) who returned to work within 5 years after being diagnosed with cervical cancer. Patients who underwent surgical treatment were more likely to RTW by the 5th year compared to other groups, with a hazard ratio (HR) of 1.21 (95% CI: 1.01~1.44). Small company size and a monthly income greater than NT 38,200 were inversely associated with RTW (HR = 0.91, 95% CI: 0.84~0.98 and HR = 0.48, 95% CI: 0.44~0.53). Furthermore, RTW showed a statistically significant decrease in the risk of all-cause mortality in the fully adjusted HR, (HR = 0.42, p < 0.001). Some medical and occupational factors are associated with RTW in cervical cancer survivors. Returning to work may have a beneficial effect on the survival of patients with cervical cancer.


2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 11548-11548
Author(s):  
Olga Vornicova ◽  
Jay Wunder ◽  
Peter W. M. Chung ◽  
Abha A. Gupta ◽  
Rebecca Anne Gladdy ◽  
...  

11548 Background: The mainstay therapy of operable STS remains surgery, which may include (neo)adjuvant therapies. Within the TSP, marginally inoperable STS are often treated with sequential chemo (CTX) and radiation (RT) therapy, followed by surgery (SX). Herein we present our experience of multi-modality therapies for marginally inoperable STS patients (pts). Methods: This was a dual-center, single program, retrospective review. Pts were included if deemed to have marginally inoperable primary or recurrent STS, as determined at the TSP tumor board. Pts included must have had CTX with the intent of having RT and SX after. Pts demographics, treatment details and clinical outcomes data were collected. Relapse free survival (RFS) and overall survival (OS) were estimated using the Kaplan-Meier method. Multivariate analysis of the influence of disease characteristics and treatment on outcomes was assessed using Cox regression. Results: From June 2005 to May 2019, 75 pts were identified. Median age was 52 years (range 16-72). Pts were predominantly male (55%). Histological subtypes included dedifferentiated liposarcoma (29%), leiomyosarcoma (27%), synovial sarcoma (19%) and others (25%). Primary tumor was located in the retroperitoneum (48%), extremity (23%), pelvis (12%), thorax (9%), and other sites (8%). All pts had doxorubicin and ifosfamide CTX (median 4 cycles; range 1-6), while RT dose delivered was 50.4Gy/28 fractions in 58 (77%) of cases. Twenty three pts (31%) achieved partial response, 40 pts (53%) had stable disease and 12 pts (16%) had progression of disease (PD) on CTX, of which half (8%) did not undergo further treatment. Nine pts (12%) underwent CTX followed by SX due to significant response, 9 pts (12%) underwent CTX and RT without SX due to persistent tumor unresectability or PD. The final 50 pts (67%) completed multi-modality treatment (CTX, RT & SX). Overall, 59 pts (79%) had SX; negative margins were achieved in 53 (71%). 19 pts (25%) had postoperative complications, causing death in 2 pts (2.7%). With a median follow-up of 72 months, median RFS and OS were 26.9 months (95% CI: 0-86.0), and 65 months (95% CI: 13.5-116.4). Extremity location was associated with superior RFS (median not reached [NR], HR 0.28 95% CI 0.09-0.83, p = 0.022), and OS (median NR, HR 0.29 95% CI 0.09-0.90, p = 0.032). Receipt of RT was associated with superior RFS (median NR, HR 0.23 95% CI 0.10-0.52, p < 0.001); and OS (median NR, HR 0.21 95% CI 0.09-0.50, p < 0.001). Pts who had PD after CTX were associated with poor outcomes - RFS (median 4.7 months, HR 2.03 95% CI 0.61-6.76, p = 0.24); and OS (median 21.9 months, HR 2.48 95% CI 0.73-8.47, P = 0.144). Conclusions: Multi-modality approach resulted in successful resection for most pts with marginally inoperable STS. Extremity location and RT administration were associated with better RFS and OS, while progression on CTX confers worse survival outcomes.


Author(s):  
Rongrong Wei ◽  
Xinyu Du ◽  
Jing Wang ◽  
Qi Wang ◽  
Xiaojie Zhu ◽  
...  

Introduction: The incidence and prognostic impact of subsequent primary gastric cancer (GC) in a population of other cancer survivors is unclear. We aimed to evaluate susceptibility to subsequent primary GC in cancer survivors and prognosis of GC with prior cancer history. Methods: 2,211 and 23,416 GC cases with and without prior cancer history were retrospectively selected from the Surveillance, Epidemiology and End Results (SEER) database. Potential risk of developing subsequent primary GC was assessed through standardized incidence ratios (SIRs). Cox regression were adopted to analyze the influence of prior cancer history and clinical characteristic factors on the prognosis of subsequent primary GC. A nomogram was established to predict overall survival (OS). Propensity score matching (PSM) was conducted to eliminate possible bias. Results: Compared with general population, cancer survivors had an increased risk of subsequent primary GC (SIR 1.17, 95% CI 1.15-1.20, P<0.05). Prior cancer history was related to poor OS of GC [adjusted hazard ratio (aHR) 1.12, 95% CI 1.06-1.19, P<0.001], but not cancer-specific survival (aHR 0.97, 95% CI 0.89-1.05, P=0.441). In addition, age, grade, stage, year of diagnosis, surgery, TNM stage and tumor size were independent prognostic factors for OS in GC cases with prior cancers. The concordance index of the nomogram was 0.72 (95% CI 0.71-0.74), and calibrate curves showed good agreement between prediction by the nomogram and actual observation. Conclusions: Cancer survivors with increased risk of developing subsequent primary GC should strengthen their monitoring and follow-up to prevent occurrence of subsequent primary gastric cancer.


2020 ◽  
Vol 38 (4_suppl) ◽  
pp. 345-345
Author(s):  
Michelle Ju ◽  
Matthew R. Porembka

345 Background: Accurate clinical staging (CS) in gastric cancer is critical for appropriate treatment selection and prognostication, but CS remains highly ineffective. Our study aims to evaluate the factors associated with inaccurate CS, the impact of inaccurate CS on patient outcomes, and effect of adjuvant therapy in patients with inaccurate CS. Methods: We conducted a retrospective review of the NCDB of patients diagnosed with clinical early-stage gastric adenocarcinoma based on AJCC 8th edition (cT1-2, N0, M0) between 2004-2016. Those who did not undergo upfront surgery or had missing pathologic staging data were excluded. Patients were classified into 3 groups: accurately staged (AS) if pathologic staging confirmed early-stage cancer, inaccurately staged with receipt of adjuvant therapy (IS+), and inaccurately staged with no receipt of adjuvant therapy (IS-). Logistic regression using stepwise selection was utilized to assess the impact of factors on CS accuracy and receipt of adjuvant therapies. Kaplan-Meier and Cox Proportional Hazard methods were used to compare survival outcomes. Results: Approximately 39% of patients (2841/7199) were understaged. T2 tumors, non-well differentiated tumors, and diffuse type histology were associated with increased likelihood of inaccurate CS. Age >60, female sex, Asian/Black race, and non-cardia tumor location were associated with decreased likelihood of inaccurate CS. Only 44% of patients who were inaccurately staged received adjuvant chemotherapy/radiation. Age >75 and fundus/body tumor location were associated with decreased likelihood of receiving adjuvant therapies, while more advanced pT and pN stage were associated with increased likelihood. Treatment facility type (community vs. academic) had no impact on likelihood of accurate CS or receipt of adjuvant treatment after inaccurate CS. 5-year overall survival was significantly different between groups (71.7% AS, 48.3% IS+, 51.1% AS-; p<0.001). Conclusions: CS is inadequate, and understaging has detrimental effects on patient survival outcomes. Novel strategies for improved CS are needed to improve patient care.


2021 ◽  
Vol 11 ◽  
Author(s):  
Song Wang ◽  
Yiyuan Zhang ◽  
Fangxu Yin ◽  
Xiaohong Wang ◽  
Zhenlin Yang

BackgroundInvasive micropapillary breast carcinoma (IMPC) is a relatively rare pathological type of invasive breast cancer. Little is currently known on the efficacy and safety of breast-conserving treatment (BCT, lumpectomy plus postsurgical radiation) compared with mastectomy in women diagnosed with early-stage IMPC. Accordingly, we sought to investigate the long-term prognostic differences between BCT and mastectomy in patients with T1-3N0-3M0 invasive micropapillary breast carcinoma using data from the Surveillance, Epidemiology, and End Results (SEER) database.Materials and MethodsWe retrospectively analyzed 1,203 female patients diagnosed with early-stage IMPC between 2004 and 2015 from the SEER database. The impact of different surgical approaches on patient prognosis was assessed by the Kaplan-Meier method and Cox proportional risk models.ResultsA total of 609 and 594 patients underwent mastectomy and BCT, respectively. Compared with patients who underwent a mastectomy, patients in the BCT group were older and had lower tumor diameters, lower rates of lymph nodes metastasis, and higher rates of ER receptor positivity and PR receptor positivity (p &lt; 0.05). Kaplan-Meier plots showed that the overall survival (OS) and breast cancer-specific survival (BCSS) were higher in the BCT group than in the mastectomy group. In subgroup analysis, patients with T2 stage in the BCT group had better OS than the mastectomy group. Multivariate analysis showed no statistical difference in OS and BCSS for patients in the mastectomy group compared with the BCT group (hazard ratio (HR) = 0.727; 95% confidence interval (95% CI) 0.369–1.432, p = 0.357; HR = 0.762; 95% CI 0.302–1.923, p = 0.565; respectively). During the multivariate analysis and stratifying for the T stage, a better OS was found for patients with T2 stage in the BCT group than the mastectomy group (HR = 0.333, 95% CI: 0.149–0.741, p = 0.007). There was no significant difference in OS for patients with T1 and T3 stages between the BCT and mastectomy groups (p &gt; 0.05).ConclusionIn women with early-stage IMPC, BCT was at least equivalent to mastectomy in terms of survival outcomes. When both procedures are feasible, BCT should be recommended as the standard surgical treatment, especially for patients with T2 disease.


2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
F Ali ◽  
M Jha

Abstract Background Factors related to CRC survival include age, tumour site and stage. Other factors that may play a role on survival include race and socioeconomic status(SES).We aim to investigate the impact of SES on CRC survival. Method All patients diagnosed with CRC between January 2006-January 2019 were included. Demographics were collected from a prospective database. SES was defined using the Index of Multiple Deprivation(IMD).Cox-regression was used to investigate the effect of factors on survival and Kaplan-Meier to estimate survival. Results A total of 5,073 patients diagnosed with CRC with a median follow up of 65 months were include. Overall survival was 72.2% (76.0%0-78.4%), 59.6%(58.2%-61.0%) and 50.3% (48.8%-51.8%) at 1 year, 3 years and 5 years, respectively. Colon cancer was associated with worse survival(p = 0.00256,HR = 1.163). On multivariate analysis, socioeconomic deprivation was associated with poorer survival (HR = 1.02,p=0.00302).Male and female sex were associated with similar survival outcomes(HR = 0.9831 and 0.9341,respectively; p = 0.986 and 0.946 respectively). Conclusions SES impact on CRC survival seems to be inconsistent across the literature potentially due to lack of uniformity of indices used to assess SES and the heterogeneity of access to healthcare. This could ultimately impact comparability across different studies investigating the impact SES on CRC survival.


2020 ◽  
Vol 18 (5) ◽  
pp. 575-581
Author(s):  
Omar Abdel-Rahman ◽  
Hatim Karachiwala ◽  
Jacob C. Easaw

Background: This study assessed the patterns of opioid use among patients with advanced gastrointestinal cancers who were included in 8 clinical trials and evaluated the impact of opioid use on survival outcomes of included patients. Methods: Deidentified datasets from 8 clinical trials evaluating first-line systemic treatment of advanced gastrointestinal cancers were accessed from the Project Data Sphere platform (ClinicalTrial.gov identifiers: NCT01124786, NCT00844649, NCT00290966, NCT00678535, NCT00699374, NCT00272051, NCT00305188, and NCT00384176). These trials evaluated patients with pancreatic carcinoma, gastric carcinoma, hepatocellular carcinoma (HCC), and colorectal carcinoma. Multivariable logistic regression analysis was used to evaluate factors predicting the use of opioids. Kaplan-Meier survival estimates were used to compare survival outcomes in each disease entity among patients who did or did not receive opioid treatment. Multivariable Cox regression analysis was then used to further assess the impact of opioid use on survival outcomes in each disease entity. Results: A total of 3,441 participants were included in the current analysis. The following factors predicted a higher probability of opioid use within logistic regression analysis: younger age at diagnosis (odds ratio [OR], 0.990; 95% CI, 0.984–0.997; P=.004), nonwhite race (OR for white vs nonwhite, 0.749; 95% CI, 0.600–0.933; P=.010), higher ECOG score (OR for 1 vs 0, 1.751; 95% CI, 1.490–2.058; P<.001), and pancreatic primary site (OR for colorectal vs pancreatic, 0.241; 95% CI, 0.198–0.295; P<.001). Use of opioids was consistently associated with worse overall survival (OS) in Kaplan-Meier survival estimates of each disease entity (P=.008 for pancreatic cancer; P<.001 for gastric cancer, HCC, and colorectal cancer). In multivariable Cox regression analysis, opioid use was associated with worse OS among patients with pancreatic cancer (hazard ratio [HR], 1.245; 95% CI, 1.063–1.459; P=.007), gastric cancer (HR, 1.725; 95% CI, 1.403–2.122; P<.001), HCC (HR, 1.841; 95% CI, 1.480–2.290; P<.001), and colorectal cancer (HR, 1.651; 95% CI, 1.380–1.975; P<.001). Conclusions: Study findings suggest that opioid use is consistently associated with worse OS among patients with different gastrointestinal cancers. Further studies are needed to understand the underlying mechanisms of this observation and its potential implications.


2013 ◽  
Vol 62 (1) ◽  
pp. 8-12 ◽  
Author(s):  
Cláudia Débora Silberman ◽  
Cláudia Soares Rodrigues ◽  
Eliasz Engelhardt ◽  
Jerson Laks

OBJECTIVE: The aim of this study is to evaluate the survival rate in a cohort of Parkinson's disease patients with and without depression. METHODS: A total of 53 Parkinson's disease subjects were followed up from 2003-2008 and 21 were diagnosed as depressed. Mean time of follow up was 3.8 (SD 95% = 1.5) years for all the sample and there was no significant difference in mean time of follow up between depressed and nondepressed Parkinson's disease patients. Survival curves rates were fitted using the Kaplan-Meier method. In order to compare survival probabilities according to the selected covariables the Log-Rank test was used. Multivariate analysis with Cox regression was performed aiming at estimating the effect of predictive covariables on the survival. RESULTS: The cumulative global survival of this sample was 83% with nine deaths at the end of the study - five in the depressed and four in the nondepressed group, and 55.6% died in the first year of observation, and none died at the fourth and fifth year of follow up. CONCLUSION: Our finding point toward incremental death risk in depressed Parkinson's disease patients.


PeerJ ◽  
2021 ◽  
Vol 9 ◽  
pp. e12277
Author(s):  
Likui Fang ◽  
Guocan Yu ◽  
Wenfeng Yu ◽  
Gang Chen ◽  
Bo Ye

Background WD repeat domain 76 (WDR76) is a predicted member of the WD40-repeat-containing domain superfamily and possibly involves in various biological processes, but its function in cancers is poorly characterized. This study aimed to evaluate the role of WDR76 in the prognosis and immune infiltrates of lung adenocarcinoma (LUAD). Methods WDR76 expressions in LUAD tissues and normal tissues were primarily compared by The Cancer Genome Atlas (TCGA) database, and were validated in cohorts from Gene Expression Omnibus (GEO) database. The associations between WDR76 expression and clinicopathologic characteristics were analyzed. Kaplan–Meier and Cox regression analyses were performed to determine the impact of WDR76 expression on survival outcomes. The protein interaction network of WDR76 was built using STRING website. TIMER and GEPIA databases were used to investigate the correlation between WDR76 expression and immune infiltrates. Results WDR76 expression was elevated in LUAD (P < 0.001) and high WDR76 expression was associated with advanced N stage, M stage and pathologic stage. Expectedly, high WDR76 expression significantly correlated with poor survival outcomes and was the independent risk factor for overall survival (OS) (HR 1.468, 95% CI [1.031–2.089], P = 0.033) and disease specific survival (DSS) (HR 1.764, 95% CI [1.095–2.842], P = 0.020). DDB1 and LSH were the important proteins interacting with WDR76. WDR76 expression correlated with CD8+ T cells presence and was also positively associated with levels of inhibitory receptors. Conclusion WDR76 expression was involved in the regulation of immune infiltrates and had predictive value for prognosis in LUAD.


2021 ◽  
Author(s):  
Omar Abdel-Rahman ◽  
Sheryl L. Koski

Objective: To assess the survival differences between cisplatin/etoposide versus carboplatin/etoposide chemotherapy regimens in the management of extra-pulmonary neuroendocrine carcinomas (NECs). Methods: Administrative cancer care databases in the province of Alberta, Canada were reviewed, and patients with extra-pulmonary NECs (including those with small cell and large cell neuroendocrine carcinomas) who were treated with either cisplatin/ etoposide or carboplatin/ etoposide, 2004-2019, were reviewed. Kaplan-Meier survival estimates were used to compare the survival outcomes according to the type of platinum agent, and multivariable Cox regression analysis was used to assess the impact of the type of platinum agent on overall survival outcomes. Results: A total of 263 eligible patients were included in this analysis. These include 176 patients who received cisplatin/ etoposide and 87 patients who received carboplatin/etoposide. Using Kaplan-Meier survival estimates, patients treated with cisplatin have better overall survival compared to patients treated with carboplatin (P=0.005). Multivariable Cox regression analysis suggested that the following factors were associated with worse overall survival: higher Charlson comorbidity index (HR: 1.17; 95% CI: 1.05-1.30), gastrointestinal primary site (HR: 1.55; 95% CI: 1.12-2.14), stage IV disease (HR: 1.75; 95% CI: 1.28-2.38) and use of carboplatin (HR: 1.40; 95% CI: 1.02-1.92). Conclusions: The current study suggested that cisplatin/etoposide might be associated with better overall survival compared to carboplatin/etoposide among patients with extra-pulmonary NECs. It is unclear if this is related to differences in inherent responsiveness to the two platinum agents, or due to differences in comorbidity burden between the two treatment groups.


Sign in / Sign up

Export Citation Format

Share Document