Factors associated with suicidal ideation risk in head and neck cancer: A longitudinal study.

OBJECTIVES/HYPOTHESIS: The risk factors associated with suicidal ideation among patients with head and neck cancer (HNC) have rarely been investigated. Thus, this study proposed an effective screening model to facilitate the identification of patients with HNC who are at risk of committing suicide. STUDY DESIGN: Retrospective longitudinal study. METHODS: We recruited 286 inpatients with HNC who were referred to the psychiatry department for an emotional distress assessment during cancer treatment. Sociodemographic and clinical factors, as well as Distress Thermometer (DT) scoring, were gathered and analyzed using multivariate logistic regression. RESULTS: Among the patients, 27 (9.4%) were recognized as having suicidal ideation. A logistic regression analysis revealed five significant indicators associated with suicidal ideation, namely depression (odds ratio [OR]: 42.83), dysphoria (OR: 8.06), hypopharyngeal cancer (OR: 4.61), cancer history (OR: 4.53), and average DT scores (OR: 1.84). Based on the receiver operating characteristic and logistic regression, the model can predict suicidal ideation with 93.4% accuracy (area under the curve value). CONCLUSIONS: Our findings provide strong evidence that patients with depression, hypopharyngeal cancer, higher DT scores, and previous cancer history can be quickly screened for suicidal ideation, which may help to prevent suicide events in patients with HNC. LEVEL OF EVIDENCE: 3b Laryngoscope, 129:2491-2495, 2019.

Impact of varying anatomic sites on advanced stage and survival of oral cancer: 9-year prospective cohort of 27 717 cases.

BACKGROUND: To elucidate the impact of varying anatomic sites on advanced stage of and death from oral cancer. METHODS: A total of 27 717 oral cancers mainly from a population-based visual inspection program in Taiwan from 2004 to 2009 was followed until the end of 2012. RESULTS: Using lip cancer as reference, the odds ratios (95% confidence interval [CI]) of advanced stage of cancer were 2.20 (1.92-2.51) for tongue, 2.60 (2.28-2.97) for buccal, 2.68 (2.20-3.28) for floor of mouth, 2.96 (2.52-3.47) for hard palate, 6.04 (5.17-7.05) for gingiva, and 10.83 (9.20-12.74) for oropharynx. The estimated hazard ratios (95% CI) for oral cancer death increased from 1.48 (1.31-1.67) in buccal, 1.61 (1.43-1.82) in tongue, 1.68 (1.41-1.99) in floor of mouth, 1.79 (1.57-2.05) in gingiva, 1.97 (1.71-2.26) in hard palate, and 2.15 (1.89-2.45) in oropharynx. CONCLUSION: Different anatomic sites had variations in advanced stage of and death from oral cancer and need vigilant surveillance.

The Impact of Metronomic Adjuvant Chemotherapy in Patients with Advanced Oral Cancer.

BACKGROUND: This study evaluated the efficacy of tegafur-uracil for advanced oral cancer. METHODS: From January 2008 to December 2013, clinical data from 356 patients with stage III or IV oral squamous cell carcinoma who received curative surgical resection and postoperative concurrent chemoradiotherapy, treated with or without tegafur-uracil, were analyzed from a prospectively designed database. Tegafur-uracil was orally administered to 114 of the 356 patients. Disease-specific survival (DSS), disease-free survival (DFS), and overall survival (OS) rates were studied. RESULTS: In our study, the 5-year OS (p = 0.0008), DFS (p = 0.0034), and DSS (p = 0.0029) rates were significantly better in the tegafur-uracil group than in the control group. Distant metastasis occurred in 16.28% of patients in the tegafur-uracil group and 45.28% in the control group (odds ratio 4.3). The distant metastasis rate in the tegafur-uracil group was significantly lower than the control group, indicating that administration of tegafur-uracil after curative surgical treatment and concurrent chemoradiotherapy prevented distant metastasis and improved the OS, DFS, and DSS rate. CONCLUSIONS: The result of tegafur-uracil treatment in patients with advanced oral cancer showed significant improvement in the 5-year OS, DFS, and DSS rate, while also showing a decreased distant metastasis rate. Tegafur-uracil treatment is a useful, effective, and well-tolerated anticancer treatment for advanced oral cancer.

Osthole induces human nasopharyngeal cancer cells apoptosis through Fas-Fas ligand and mitochondrial pathway.

Nasopharyngeal carcinoma (NPC) is endemic in Southern China and Southeast Asia. The present study investigated the activity of osthole in suppressing NPC along with the underlying mechanism. Cell growth inhibition was measured using the MTT assay. Apoptosis was detected through 4',6-diamidino-2-phenylindole staining and flow cytometry. Western blotting was used to identify the signaling pathway. Osthole markedly inhibited cell proliferation and induced apoptosis in the NPC cell line. Western blotting results revealed the increased activation of caspases 3, 8, and 9 and poly (ADP-ribose) polymerase. Osthole treatment significantly reduced the expression of the antiapoptotic protein Bcl-2 and increased the expression of the proapoptotic proteins Bax, Bak, BimL, BimS, and t-Bid. Osthole treatment also increased the expression of Fas, FADD, TNF-R1, TNF-R2, DcR2, RIP, and DR5. In addition, osthole treatment significantly increased the expression levels of phosphorylated ERK1/2 and JNK1/2. These results suggested that osthole exerts cytotoxic effects on NPC cell lines mainly through apoptosis mediated by the Fas-Fas ligand and mitochondrial pathway. Osthole could be a potential anticancer agent for NPC.

Population-based screening program for reducing oral cancer mortality in 2,334,299 Taiwanese cigarette smokers and/or betel quid chewers.

BACKGROUND: To reduce oral cancer mortality, an organized, population-based screening program for the early detection of oral premalignancy and oral cancer was designed for high-risk individuals with habits of betel quid chewing, cigarette smoking, or both. The objective of this report was to evaluate the long-term effectiveness of this program in reducing the incidence of advanced disease and deaths from oral cancer. METHODS: A nationwide, population-based screening program for oral cancer has been conducted in Taiwan since 2004. Residents aged ≥ 18 years with oral habits of cigarette smoking and/or betel quid chewing were invited. The standardized mortality ratio method was used to compare the observed numbers of advanced oral cancers and deaths from oral cancer among screening attendees with the expected numbers derived from mortality among nonattendees. An intention-to-treat analysis of the relative rate of reductions in advanced-stage oral cancers and oral cancer mortality also was conducted. RESULTS: The overall screening rate was 55.1%. The relative risk of death from oral cancer was 0.53 (95% confidence interval [CI], 0.51-0.56) as a result of screening compared with the expected risk of oral cancer deaths in the absence of screening. The corresponding relative risk was 0.74 (95% CI, 0.72-0.77) after adjusting for self-selection bias. The relative risk of advanced oral cancer for the screened group versus the nonscreened group was 0.62 (95% CI, 0.59-0.64), which increased to 0.79 (95% CI, 0.76-0.82) after adjustment for self-selection bias. CONCLUSIONS: An organized, population-based oral cancer screening program targeting more than 2 million Taiwanese cigarette smokers and/or betel quid chewers demonstrated the effectiveness of reducing stage III or IV oral cancers and oral cancer mortality. These evidence-based findings corroborate and support the screening strategy of oral visual inspection for the prevention of oral cancer among high-risk individuals in areas with a high incidence of oral cancer. Cancer 2017;123:1597-1609. © 2017 American Cancer Society.

Faecal haemoglobin concentration influences risk prediction of interval cancers resulting from inadequate colonoscopy quality: analysis of the Taiwanese Nationwide Colorectal Cancer Screening Program.

OBJECTIVES: Interval colorectal cancer (CRC) after colonoscopy may affect effectiveness and cost-effectiveness of screening programmes. We aimed to investigate whether and how faecal haemoglobin concentration (FHbC) of faecal immunochemical testing (FIT) affected the risk prediction of interval cancer (IC) caused by inadequate colonoscopy quality in a FIT-based population screening programme. DESIGN: From 2004 to 2009, 29 969 subjects underwent complete colonoscopy after positive FIT in the Taiwanese Nationwide CRC Screening Program. The IC rate was traced until the end of 2012. The incidence of IC was calculated in relation to patient characteristics, endoscopy-related factors (such adenoma detection rate (ADR)) and FHbC. Poisson regression analysis was performed to assess the potential risk factors for colonoscopy IC. RESULTS: One hundred and sixty-two ICs developed after an index colonoscopy and the estimated incidence was 1.14 per 1000 person-years of observation for the entire cohort. Increased risk of IC was most remarkable in the uptake of colonoscopy in settings with ADR lower than 15% (adjusted relative risk (aRR)=3.09, 95% CI 1.55 to 6.18) and then higher FHbC (µg Hb/g faeces) (100-149: aRR=2.55, 95% CI 1.52 to 4.29, ≥150: aRR=2.74, 95% CI 1.84 to 4.09) with adjustment for older age and colorectal neoplasm detected at baseline colonoscopy. Similar findings were observed for subjects with negative index colonoscopy. CONCLUSIONS: Colonoscopy ICs arising from FIT-based population screening programmes were mainly influenced by inadequate colonoscopy quality and independently predicted by FHbC that is associated with a priori chance of advanced neoplasm. This finding is helpful for future modification of screening logistics based on FHbC.

Population-Based Breast Cancer Screening With Risk-Based and Universal Mammography Screening Compared With Clinical Breast Examination: A Propensity Score Analysis of 1 429 890 Taiwanese Women.

IMPORTANCE: Different screening strategies for breast cancer are available but have not been researched in quantitative detail. OBJECTIVE: To assess the benefits and the harms of risk-based and universal mammography screening in comparison with annual clinical breast examination (CBE). DESIGN: Population-based cohort study comparing incidences of stage II+ disease and death from breast cancer across 3 breast cancer screening strategies, with adjustment for a propensity score for participation based on risk factors for breast cancer and comparing the 3 strategies for overdetection between January 1999 and December 2009. Asymptomatic women attending outreach screening in the community or undergoing mammography in hospitals were enrolled in the 3 screening programs. INTERVENTIONS: Risk-based biennial mammography, universal biennial mammography, and annual CBE. MAIN OUTCOMES AND MEASURES: Detection rates, stage II+ disease incidence, mortality from breast cancer, and overdiagnosis were compared using a time-dependent Cox proportional hazards regression model. RESULTS: A total of 1 429 890 asymptomatic women attending outreach screening in the community or undergoing mammography in hospitals were enrolled in the 3 screening programs. Detection rates (prevalent screen and subsequent screens per 1000) were the highest for universal biennial mammography (4.86 and 2.98, respectively), followed by risk-based mammography (2.80 and 2.77, respectively), and lowest for annual CBE (0.97 and 0.70, respectively). Universal biennial mammography screening, compared with annual CBE, was associated with a 41% mortality reduction (risk ratio, 0.59; 95% CI, 0.48-0.73) and a 30% reduction of stage II+ breast cancer (RR, 0.70; 95% CI, 0.66-0.74). Risk-based mammography screening was associated with an 8% reduction of stage II+ breast cancer (RR, 0.92; 95% CI, 0.86-0.99) but was not associated with a statistically significant mortality reduction (risk ratio [RR], 0.86; 95% CI, 0.73-1.02). Estimates of overdiagnosis were no different from CBE for risk-based screening and 13% higher than CBE for universal mammography. CONCLUSIONS AND RELEVANCE: Compared with population-based screening for breast cancer with annual CBE, universal biennial mammography resulted in a substantial reduction in breast cancer deaths, whereas risk-based biennial mammography resulted in only a modest benefit. Compared with annual CBE, risk-based and universal mammography screening did not result in significant overdiagnosis of breast cancer.

An endoscopic training model to improve accuracy of colonic polyp size measurement.

PURPOSE: Most studies of colonic polyps rely on visual estimation when regarding polyp size; however, the reliability of a visual estimate is questionable. Our study aims to develop a training model to improve the accuracy of size estimation of colonic polyps in vivo. METHODS: Colon polyps were recorded on 160 video clips during colonoscopy. The size of each polyp was estimated by visual inspection and subsequently measured with a flexible linear measuring probe. The study included a pretest, an intervention, and a posttest. The pretest included 160 video clips, which comprised the visual-estimation portion of the study. The intervention was an educational model consisting of 30 video clips which included a visual-estimation section and a linear-measuring-probe section, designed to help the endoscopists to compare their visual estimate of size with the measured size of the polyps. The posttest included the 160 video clips used in the pretest, presented in random order. Intraobserver agreement and diagnostic accuracy were compared before and after the training session. RESULTS: Eight beginners and four experienced colonoscopists were enrolled. The overall kappa (kappa) values of intraobserver agreement for pretest and posttest were 0.74 and 0.85 for beginner group as well as 0.83 and 0.88 for experienced group, respectively. The overall diagnostic accuracy improved from 0.52 to 0.78 for beginner group and 0.71 to 0.87 for experienced group (P < 0.05) after education with the training model. CONCLUSIONS: This training model could help endoscopists improve the accuracy of measurement of polyps on colonoscopy in a short period. The durability of learning effect needs further investigation.

Emergency endoscopy for upper gastrointestinal bleeding in patients with coronary artery disease.

BACKGROUND: Endoscopy is useful for diagnosis and treatment of upper gastrointestinal bleeding (UGIB). However, both endoscopy and UGIB may compromise the cardiovascular function. The present study is to investigate the cardiovascular responses of emergency endoscopy for patients with UGIB and stable coronary artery disease (CAD). METHODS: Consecutive 50 patients with known CAD and 50 patients without CAD history (non-CAD group) in whom emergency endoscopy was requested for UGIB were prospectively enrolled. All patients received ambulatory electrocardiographic monitoring before, during, and after endoscopies. Cardiac indices including supraventricular and ventricular arrhythmia, ST ischemic change, and autonomic nervous function evaluated by heart rate variability were compared. RESULTS: All patients in both groups had successful primary hemostasis, and peptic ulcer bleeding was the main etiology (82%). Compared with the non-CAD group, patients with CAD had a significantly higher incidence (42% vs 16%, P = .004) and frequency (1.19 vs 0.12 events per minute, P = .003) of ventricular arrhythmias during endoscopy. Nine patients with CAD and 1 patient without CAD had ischemic ST changes (P = .016). Comorbidity with congestive heart failure was not only associated with a higher frequency (P = .02) but also a more severe fluctuation (P = .002) of ventricular arrhythmia. None in both groups had angina or MI before, during, or after endoscopy. Heart rate variability did not show a difference. CONCLUSIONS: Ventricular arrhythmias and myocardial ischemia, although mostly subclinical, were common in patients with stable CAD undergoing emergent endoscopy for UGIB, especially in those with concomitant congestive heart failure.