scholarly journals Utilization of imaging for active surveillance in testicular cancer: Is real-world practice concordant with guidelines?

2021 ◽  
Vol 16 (2) ◽  
Author(s):  
Bishal Gyawali ◽  
Rebecca Griffiths ◽  
Andrew G. Robinson ◽  
Matthew D.F. McInnes ◽  
Philippe L. Bedard ◽  
...  
Keyword(s):  
Testicular Cancer ◽  
Active Surveillance ◽  
Early Stage ◽  
Multivariable Analysis ◽  
Germ Cell Tumors ◽  
Population Based ◽  
Chest Imaging ◽  
Imaging Data ◽  
Period Range ◽  
Ontario Cancer Registry

Introduction: Imaging is an integral component of active surveillance following orchiectomy for stage 1 non-seminoma (NSGCT) and seminoma germ cell tumors. In this population-based study, we describe use of imaging among patients with early-stage testicular cancer and evaluate whether they are concordant with guideline recommendations. Methods: This is a population-based, retrospective cohort study to describe utilization of imaging among all patients with early-stage testicular cancer treated with active surveillance in the Canadian province of Ontario. The Ontario Cancer Registry was linked to electronic records of treatment to identify use of chest and abdomen/pelvis imaging. Data from 2000–-2010 were included with followup for up to five years for patients with non-seminoma and 10 years for patients with seminoma. The key outcome of interest was the frequency of imaging at temporal milestones following orchiectomy. Compared to the most contemporaneous guidelines in Ontario, any discordant frequency of imaging was defined as underutilization or overutilization. Substantial under- or overutilization was defined as >1 imaging test less/more than what was recommended during a 12-month period. Results: The study population included 569 patients with NSGCT (median age 28) and 1107 with seminoma (median age 37). Among patients with NSGCT, adherence with body imaging was low in years 1–3 of surveillance (range 26–37%, predominantly underuse) and higher in years 4–5 (63–67%, predominantly overuse). Adherence with chest imaging was even lower (range 11–34% during years 1–5). Among patients with seminoma, adherence with abdominal and chest imaging was relatively stable and comparable throughout the 10-year followup period (range 23–47% abdomen and 28–47% chest). Multivariable analysis confirmed that underutilization of imaging was more common in recent years. NSGCT histology was associated with underutilization in years 1–2 but overutilization in years 3–5. Conclusions: In routine clinical practice, patients with testicular cancer commonly receive imaging discordant to the protocol for active surveillance, with a substantial proportion receiving both under- and overutilization at various times during surveillance followup.

scholarly journals A population-based study of pulmonary monitoring and toxicity for patients with testicular cancer treated with bleomycin

2020 ◽  
Vol 27 (6) ◽  
Author(s):  
M.J. Raphael ◽  
M.D. Lougheed ◽  
X. Wei ◽  
S. Karim ◽  
A.G. Robinson ◽  
...  
Keyword(s):  
Testicular Cancer ◽  
Pulmonary Toxicity ◽  
Pulmonary Function Tests ◽  
Population Based ◽  
Primary Objective ◽  
Administrative Databases ◽  
Chest Imaging ◽  
Physician Visits ◽  
Ontario Cancer Registry ◽  
Incident Cases

Background Bleomycin is commonly used to treat advanced testicular cancer and can be associated with severe pulmonary toxicity. The primary objective of the present study was to describe the use of pulmonary function tests (pfts) and chest imaging before, during, and after treatment with bleomycin. Methods To identify all incident cases of testicular cancer treated with bleomycin-based chemotherapy in the Canadian province of Ontario during 2005–2010, the Ontario Cancer Registry was linked with chemotherapy treat­ment records. Health administrative databases were used to describe use of pfts, chest imaging, and physician visits for respiratory complaints. Results Of 394 patients treated with orchiectomy and chemotherapy who received at least 1 dose of bleomycin, 93% had complete chemotherapy records available. In the 4 weeks before, during, and within 2 years after finishing bleomycin-based chemotherapy, pfts were performed in 17%, 17%, and 29% of patients respectively. Chest imaging was performed in 68%, 62%, and 98% of patients in the same time periods. In the 2 years after bleomycin-based chemotherapy, 23% of treated patients had a physician visit for respiratory symptoms. That rate was substantially higher for men with greater exposure to bleomycin: 40% (24 of 60) for 10–12 doses bleomycin compared with 21% (53 of 250) for 7–9 doses and with 14% (8 of 58) for 1–6 doses (p = 0.002). Conclusions Quality improvement initiatives are needed to increase baseline rates of chest imaging within 4 weeks of starting chemotherapy for testicular cancer; to understand why such a high proportion of men have chest imaging during bleomycin-based chemotherapy; and to mitigate the excess pulmonary toxicity seen with increasing expos­ure to bleomycin.

Germ Cell Tumors of Undescended vs. Descended Testes: Population-Based Clinical and Outcomes Data

2012 ◽  
Vol 5 (5) ◽  
pp. 236-240
Author(s):  
Norleena P. Gullett ◽  
Timothy A. Masterson ◽  
Peter A.S. Johnstone
Keyword(s):  
Testicular Cancer ◽  
Germ Cell ◽  
Germ Cell Tumors ◽  
Relative Survival ◽  
Population Based ◽  
Similar Frequency ◽  
Nonseminomatous Germ Cell Tumor ◽  
Seer Data ◽  
Testicular Lesions ◽  
Regional Disease

Objective: Testicular cancer has been associated with undescended testes (UDT) for decades, with a relative risk of testicular cancer in cryptorchidism at 2.75–8. Tumors of UDT are infrequently encountered in clinical practice and no population-based prior analysis has described clinical patterns of care in their case. Methods: Information on malignant testicular lesions was retrieved from the population-based Surveillance Epidemiology and End Results (SEER) data for the period 1983–2005. Site codes C62.0 (UDT) were compared with C62.1 (descended testis; DT), using appropriate surgical codes for the era reported. Analysis was made of the seminomatous histology codes (ICD-03 9061–9063) vs. the nonseminomatous germ cell tumor codes (ICD-03 9065–9085). Further analysis was stratified by presenting extent of disease (local, regional, or distant). Results: 462 cases of tumors of UDT were documented; 416 (90%) were germ cell tumors (GCT). In this timeframe, 7414 cases of DT GCT were described. UDT lesions were more frequently seminoma (74.7% vs. 60.8%; p< 0.0001), and diagnosed at a more advanced stage than DT lesions ( x2 = 18, p = 0.0001). Similar frequency of RT was noted for localized seminoma, whether UDT or DT, after RadOrch ( p = 0.13), and was rarely delivered for NSGCT. 5-yr observed (5YOS) and relative survival (5YRS) of seminomas did not differ between the DT and UDT cohorts, or between the DT and UDT NSGCT cohorts. Conclusions: Our results support recent literature revealing seminomas are more frequent in cryptorchid testes. RT was equally used between localized UDT and DT seminomas. Penetrance of RadOrch is similar in local and regional disease by histology. Survival is equivalent for UDT compared to DT lesions in both seminomatous and NSGCT histologies.

Contralateral prophylactic mastectomy decision-making in the population-based iCanCare study of early-stage breast cancer patients.

2016 ◽  
Vol 34 (7_suppl) ◽  
pp. 177-177
Author(s):  
Reshma Jagsi ◽  
Sarah T. Hawley ◽  
Kent A. Griffith ◽  
Nancy K. Janz ◽  
Allison W. Kurian ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Family History ◽  
Prophylactic Mastectomy ◽  
Early Stage ◽  
Multivariable Analysis ◽  
Contralateral Prophylactic Mastectomy ◽  
Population Based ◽  
Early Stage Breast Cancer ◽  
Increased Risk

177 Background: Contralateral prophylactic mastectomy (CPM) use is increasing in women who are not at increased risk of contralateral cancer development and will experience no survival benefit from the more morbid procedure. Little is known about treatment decision-making or provider interactions. Methods: We surveyed a weighted random sample of newly diagnosed patients with early-stage breast cancer who were treated in 2013-14, identified through the population-based SEER registries of Los Angeles and Georgia about 3 months after surgical treatment, and merged with SEER data (N=2632, RR=70%), to determine receipt of diagnostic tests and factors related to the decision about surgery (including knowledge and perceived physician recommendation). Results: Nearly half of 2,436 respondents with unilateral non-metastatic cancer considered CPM (25% strongly). Only 37% of those who considered CPM knew that it does not improve survival for all women with breast cancer (24% believed it does, 39% didn’t know). Among women receiving CPM, 37% believed it generally improves survival. Ultimately, 1,464 (60%) received BCS and 972 (40%) mastectomy (of whom 438, or 18% overall, received CPM). On multivariable analysis, pts who received CPM were younger, more likely to be white, and more likely to have a family history, private rather than Medicaid insurance, and received MRI. Even among pts without a deleterious genetic mutation or family history in multiple relatives (2,303), 400 (17%) received CPM. CPM was uncommon among pts who reported that their surgeons recommended against it (2.0% [17/832]) but much higher among those who reported no surgeon recommendation regarding CPM (21.3% [229/1,077]), and among those who perceived their surgeons to have recommended it (55.4% [147/265]). Conclusions: Many patients consider CPM, but knowledge is low. Use of CPM is substantial among patients without clinical indications but is low when patients report their surgeon recommended against it. In the context of shared decision-making, surgeon recommendations against CPM might help reduce potential overtreatment.

Incidence of diabetes among patients with colorectal cancer.

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 393-393
Author(s):  
Simron Singh ◽  
Paula Rochon ◽  
Geoffrey Anderson ◽  
Craig Earle ◽  
Hadas Fischer ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Multivariable Analysis ◽  
Population Based ◽  
Administrative Databases ◽  
Cox Proportional Hazard ◽  
Hazard Ratios ◽  
Ontario Cancer Registry ◽  
Few Data

393 Background: Emerging data show an increasingly recognized risk of colorectal cancer (CRC) in patients with type 2 diabetes (DM) likely due to common biologic pathways. Few data are available on DM incidence among patients with CRC. Our objective was to determine whether patients with CRC have a higher incidence of DM compared to those without CRC. Methods: We conducted a population-based retrospective cohort study in Ontario, Canada, using administrative databases comparing the incidence of DM among all CRC patients identified in the Ontario Cancer registry from Jan 1, 2002 to Dec 31, 2011 with an age-matched control population without CRC. We used Cox proportional hazard to study the association. We modeled the effect of CRC on the cause-specific hazard of developing DM and censored subjects at the time of a competing event. Subgroup analysis was performed on patients receiving chemotherapy vs. not, metastatic disease vs. not and colon vs. rectal cancer. Results: We identified 39,707 persons with CRC and 198,535 controls. The mean age was 68 and 48.6% were female. We found an overall DM incidence of 8.7% over a mean follow up time of 4.8 years. On multivariable analysis, the effect of CRC on the instantaneous hazard of the DM incidence varied over time, and thus we estimated instantaneous hazard ratios (IHR) for years 1-5 of follow up. The risk of DM among CRC patients was significantly higher than controls for at least five years post CRC diagnosis. The overall DM incidence was higher in patients with no metastasis (10.6% vs 8.6%, p<0.01), and lower in patients who received chemotherapy (8.0% vs 9.0%, p<0.01). Conclusions: This is among the first study to report an increased DM incidence among CRC survivors. This association may be due to common risk factors rather than a treatment effect, as the risk remains elevated for at least five years post diagnosis. The hazard may be underestimated, as patients with advanced cancer may not be formally diagnosed with DM. These results strengthen our understanding of the common biologic pathway of both diseases and have major implications for survivorship care in patients with CRC. [Table: see text]

scholarly journals Frequency of Surgery in Black Patients with Malignant Pleural Mesothelioma

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Emanuela Taioli ◽  
Andrea S. Wolf ◽  
Jacqueline M. Moline ◽  
Marlene Camacho-Rivera ◽  
Raja M. Flores
Keyword(s):  
Malignant Pleural Mesothelioma ◽  
Early Stage ◽  
Large Population ◽  
Multivariable Analysis ◽  
Female Gender ◽  
Population Based ◽  
Pleural Mesothelioma ◽  
Early Stage Disease ◽  
Black And White ◽  
Black Patients

Introduction. Malignant Pleural Mesothelioma (MPM) is a rare disease, even less frequently described in minority patients. We used a large population-based dataset to study the role of race in MPM presentation, treatment, and survival.Methods. All cases of pathologically proven MPM were identified in the Surveillance, Epidemiology, and End Results (SEER) database. Age, sex, diagnosis year, stage, cancer-directed surgery, radiation, and vital status were analyzed according to self-reported race (black or white).Results. There were 13,046 white and 688 black MPM patients (incidence: 1.1 per 100,000 whites; 0.5 per 100,000 blacks; age-adjusted,p=0.01). Black patients were more likely to be female, younger, and with advanced stage and less likely to undergo cancer-directed surgery than whites, after adjustment by stage. On multivariable analysis, younger age and having surgery were associated with longer survival for both cohorts; female gender (HR 0.82 (0.77–0.88)) and early stage at diagnosis (HR 0.83 (0.76–0.90)) were predictive of longer survival in white, but not in black, patients.Conclusions. Surgery was associated with improved survival for both black and white MPM patients. However, black patients were less likely to undergo cancer-directed surgery. Increased surgical intervention in MPM black patients with early stage disease may improve their survival.

Population-based cohort of prostate cancer patients on active surveillance (AS): guideline adherence, conversion to treatment and decisional regret.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 6512-6512 ◽  
Author(s):  
Sabrina Peterson ◽  
Ramsankar Basak ◽  
Dominic Himchan Moon ◽  
Claire Liang ◽  
Ram S Basak ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Active Surveillance ◽  
Prostate Biopsy ◽  
Early Stage ◽  
Multivariable Analysis ◽  
Patient Anxiety ◽  
Related Factors ◽  
Psa Testing ◽  
Patient Reported ◽  
Decisional Regret

6512 Background: AS is recommended for early-stage prostate cancer, for which over-treatment has been widely described. In published studies from large academic institutions and/or controlled clinical trials, where patients are monitored rigorously, AS is safe and results in low rates of cancer-specific mortality. However, active surveillance in the community setting has not been previously examined. Methods: In collaboration with the North Carolina state cancer registry, 346 men with newly-diagnosed low- or intermediate-risk prostate cancer throughout the state from 2011–13 who pursued active surveillance were enrolled in an observational cohort; medical records and patient-reported outcomes (validated measures of prostate cancer anxiety [MAX-PC] and Clark’s prostate cancer decision regret) were collected prospectively. Guideline-adherent monitoring during active surveillance was assessed using contemporary NCCN guidelines: PSA testing every 3–6 months and prostate biopsy within 18 months of initial diagnosis. Results: 58% of patients received adequate PSA testing and 45% prostate biopsy; overall, 32% of patients received guideline-adherent monitoring. Urology follow-up in Year 1 was 97% but dropped to 67% in Year 2. Within the first 2 years, 16% of patients converted to treatment. Multivariable analysis showed MAX-PC scores (OR 1.8, p = 0.008) and younger age were significantly associated with conversion; no other sociodemographic (race, education, marital status, rural/urban) or diagnostic variable (risk group) was associated. At 2 years, 94% expressed no regret. Conclusions: In a non-controlled setting of patients pursuing AS in the community, adherence to guideline-recommended monitoring was only 32%. Few patients expressed decisional regret. Conversion to treatment was likely driven by patient anxiety but not disease-related factors. While there are continued efforts to increase AS uptake, these results highlight the importance of behavioral interventions during active surveillance to reduce anxiety and improve monitoring adherence. Whether AS in non-controlled settings is safe and effective requires further study.

Utilization of mental health services among survivors of testicular cancer: A population-based study.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e16062-e16062
Author(s):  
Christopher M. Booth ◽  
Michael J. Raphael ◽  
Xuejiao Wei ◽  
Claudio Soares ◽  
Philippe L. Bedard ◽  
...  
Keyword(s):  
Mental Health ◽  
Psychological Distress ◽  
Testicular Cancer ◽  
Active Surveillance ◽  
Service Use ◽  
Population Based ◽  
Mental Health Service Use ◽  
Study Cohort ◽  
Testicular Cancer Survivors ◽  
Incident Cases

e16062 Background: Testicular cancer survivors may experience long-term psychological distress related to their diagnosis and treatment. Measurement of mental health service use (MHS) is an objective way to quantify the incurred burden of psychological distress. Here we describe patterns of MHS use among survivors of testicular cancer in a single-payer health system. Methods: The Ontario Cancer Registry was linked to electronic treatment records to identify all incident cases of testicular cancer treated with orchiectomy in the Canadian province of Ontario during 2004-2010. Mental health clinical visits were identified from records of hospital admission, emergency room visits and out-patient physician billing records. Results: The study cohort included 1877 patients; mean age was 35 and 61% had pure seminoma. Two thirds of patients (66%, 1230/1877) were initially treated with active surveillance. In the 2-year period prior to orchiectomy, 24% (443/1877) of patients had MHS use. Post-orchiectomy, the prevalence of MHS use was 18% (331/1877), 23% (431/1877) and 30% (572/1877) at 6, 12 and 24 months, respectively. The use of MHS was greatest in the peri-diagnostic/surgical period. Rates of MHS visits, 3 months before, 0-3 months after, 4-6 months after and 2 years after orchiectomy were 11%, 14%, 10%, and 6%, respectively. Post-orchiectomy MHS use was greatest among those with baseline MHS use. The prevalence of MHS use for patients with and without baseline MHS use was 40% (175/443) vs 11% (156/1434, p < 0.001) at 6 months; 51% (225/443) vs 14% (206/1434, p < 0.001) at 12 months; and 61% (271/443) vs 21% (301/1434, p < 0.001) at 24 months post-orchiectomy. Post-orchiectomy MHS use did not vary by initial treatment strategy (active surveillance vs upfront treatment, p = 0.435). Older patients were more likely to have MHS visits at all time periods than younger patients; MHS rates at 6 months were 15% (93/631) vs 18% (112/625) vs 20% (126/621) for ages 16-29, 30-39, and 40+ years respectively (p = 0.035). Conclusions: MHS use among survivors of testicular cancer is common, particularly in the peri-diagnostic and surgical period. The rate of MHS use is highest among those patients with a history of prior MHS use. Clinicians should screen for the presence of psychological distress among survivors of testicular cancer.

Sonographic Diagnosis of Unilateral Synchronous Testicular Tumors

2019 ◽  
Vol 2 ◽  
pp. 2
Author(s):  
Allison Forrest ◽  
Numbereye Numbere ◽  
Jerome Jean-Gilles ◽  
Thomas Frye ◽  
Vikram Dogra
Keyword(s):  
Testicular Cancer ◽  
Germ Cell ◽  
Germ Cell Tumors ◽  
Histological Type ◽  
Synchronous Tumors ◽  
Testicular Tumors ◽  
Sonographic Diagnosis ◽  
Histological Types ◽  
Common Cancer

Testicular cancer accounts for 1% of all male cancers yet is the most common cancer affecting men aged 15–44 years. Most testicular cancers are seminomas or non-seminomatous germ cell tumors. Rarely, multiple testicular cancers may occur simultaneously, most often of the same histological type. However, synchronous tumors of different histological types may occur, although rarely. In this case study, we present the sonographic features with histopathologic correlation in a case of unilateral synchronous testicular tumors of discordant histology.

scholarly journals Longitudinal deterioration of white-matter integrity: heterogeneity in the ageing population

2021 ◽  
Vol 3 (1) ◽  
Author(s):  
Konstantinos Poulakis ◽  
Robert I Reid ◽  
Scott A Przybelski ◽  
David S Knopman ◽  
Jonathan Graff-Radford ◽  
...  
Keyword(s):  
White Matter ◽  
Internal Capsule ◽  
Population Based ◽  
White Matter Integrity ◽  
Ageing Population ◽  
White Matter Tract ◽  
Imaging Data ◽  
Cognitive Assessments ◽  
Longitudinal Imaging ◽  
Systemic Health

Abstract Deterioration in white-matter health plays a role in cognitive ageing. Our goal was to discern heterogeneity of white-matter tract vulnerability in ageing using longitudinal imaging data (two to five imaging and cognitive assessments per participant) from a population-based sample of 553 elderly participants (age ≥60 years). We found that different clusters (healthy white matter, fast white-matter decliners and intermediate white-matter group) were heterogeneous in the spatial distribution of white-matter integrity, systemic health and cognitive trajectories. White-matter health of specific tracts (genu of corpus callosum, posterior corona radiata and anterior internal capsule) informed about cluster assignments. Not surprisingly, brain amyloidosis was not significantly different between clusters. Clusters had differential white-matter tract vulnerability to ageing (commissural fibres &gt; association/brainstem fibres). Identification of vulnerable white-matter tracts is a valuable approach to assessing risk for cognitive decline.

scholarly journals The Applications of Artificial Intelligence in Chest Imaging of COVID-19 Patients: A Literature Review

Diagnostics ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. 1317
Author(s):  
Maria Elena Laino ◽  
Angela Ammirabile ◽  
Alessandro Posa ◽  
Pierandrea Cancian ◽  
Sherif Shalaby ◽  
...  
Keyword(s):  
Artificial Intelligence ◽  
Literature Review ◽  
Diagnostic Imaging ◽  
Clinical Work ◽  
Rapid Expansion ◽  
Chest Imaging ◽  
Imaging Data ◽  
Prognostic Information ◽  
Quantitative Ct ◽  
Work Up

Diagnostic imaging is regarded as fundamental in the clinical work-up of patients with a suspected or confirmed COVID-19 infection. Recent progress has been made in diagnostic imaging with the integration of artificial intelligence (AI) and machine learning (ML) algorisms leading to an increase in the accuracy of exam interpretation and to the extraction of prognostic information useful in the decision-making process. Considering the ever expanding imaging data generated amid this pandemic, COVID-19 has catalyzed the rapid expansion in the application of AI to combat disease. In this context, many recent studies have explored the role of AI in each of the presumed applications for COVID-19 infection chest imaging, suggesting that implementing AI applications for chest imaging can be a great asset for fast and precise disease screening, identification and characterization. However, various biases should be overcome in the development of further ML-based algorithms to give them sufficient robustness and reproducibility for their integration into clinical practice. As a result, in this literature review, we will focus on the application of AI in chest imaging, in particular, deep learning, radiomics and advanced imaging as quantitative CT.

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