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Neoplasias de Cabeza y Cuello , Inmunoterapia , Neoplasias Pulmonares , Terapia Recuperativa , Neoplasias del Cuello Uterino , Humanos , Masculino , Neoplasias de Cabeza y Cuello/terapia , Neoplasias Pulmonares/terapia , Neoplasias Pulmonares/genética , Neoplasias Pulmonares/patología , Femenino , Terapia Recuperativa/métodos , Neoplasias del Cuello Uterino/terapia , Inmunoterapia/métodos , Neoplasias Esofágicas/terapia , Receptores ErbB/genética , Antagonistas de Andrógenos/uso terapéutico , Prostatectomía/métodos , MutaciónAsunto(s)
Oxigenoterapia Hiperbárica , Neoplasias Renales , Enfermedades Pulmonares Intersticiales , Carcinoma Nasofaríngeo , Radiocirugia , Humanos , Radiocirugia/métodos , Radiocirugia/efectos adversos , Oxigenoterapia Hiperbárica/métodos , Neoplasias Renales/radioterapia , Carcinoma Nasofaríngeo/radioterapia , Carcinoma Nasofaríngeo/terapia , Masculino , Enfermedades Pulmonares Intersticiales/etiología , Neoplasias Nasofaríngeas/radioterapia , Neoplasias Nasofaríngeas/terapia , Prostatectomía/métodos , Prostatectomía/efectos adversos , Hipofraccionamiento de la Dosis de RadiaciónRESUMEN
OBJECTIVES: To describe the trends in the nature of general practices in Scotland between 2014/15 and 2023. STUDY DESIGN: Descriptive ecological study. METHODS: We obtained data from Public Health Scotland and used general practitioner (GP) practice codes, practice names, and the General Medical Council (GMC) numbers of their listed GPs to describe trends in practice characteristics and to identify individual practices that were likely to be operating as a single entity. RESULTS: Defining practice entities is difficult because different GP practice codes are often retained when GPs are performing across multiple practices. If GP practice codes alone are used, the median practice list size increased from 5094 to 5881, and the mean from 5588 to 6289, between 2013/14 and 2020/21. There was one outlier practice that grew to have over 45,000 patients registered by 2020/21. However, this underestimates the extent of this new mega-practice phenomenon. Using the GMC numbers of GPs listed as performers to identify where the same GPs are working across multiple GP practice codes, we identified a series of mega-practices that span across health board areas and which have experienced a dramatic increase in their list size (with the two largest having list sizes of over 101,000 and 77,000 patients, respectively). CONCLUSIONS: Further research is needed to better understand: how mega-practices provide services and whether this differs from other practices; where financial rewards accumulate within mega-practices; differences in staffing between mega-practices and other models; and the impacts mega-practices have on the quality and continuity of care and on health and inequality outcomes.
Asunto(s)
Medicina General , Escocia , Humanos , Medicina General/estadística & datos numéricos , Médicos Generales/estadística & datos numéricosAsunto(s)
Neoplasias de la Mama , Radiocirugia , Humanos , Neoplasias de la Mama/patología , Neoplasias de la Mama/radioterapia , Femenino , Radiocirugia/métodos , Estadificación de Neoplasias , Probióticos/uso terapéutico , Probióticos/administración & dosificación , Ganglios Linfáticos/patología , Axila , Metástasis Linfática/patología , Ultrasonografía/métodosRESUMEN
BACKGROUND AND PURPOSE: A retrospective single-center analysis of the safety and efficacy of reirradiation to 40 Gy in 5 fractions (reSBRT) in patients previously treated with stereotactic body radiotherapy to the spine was performed. METHODS: We identified 102 consecutive patients treated with reSBRT for 105 lesions between 3/2013 and 8/2021. Sixty-three patients (61.8%) were treated to the same vertebral level, and 39 (38.2%) to overlapping immediately adjacent levels. Local control was defined as the absence of progression within the treated target volume. The probability of local progression was estimated using a cumulative incidence curve. Death without local progression was considered a competing risk. RESULTS: Most patients had extensive metastatic disease (54.9%) and were treated to the thoracic spine (53.8%). The most common regimen in the first course of stereotactic body radiotherapy was 27 Gy in 3 fractions, and the median time to reSBRT was 16.4 months. At the time of simulation, 44% of lesions had advanced epidural disease. Accordingly, 80% had myelogram simulations. Both the vertebral body and posterior elements were treated in 86% of lesions. At a median follow-up time of 13.2 months, local failure occurred in 10 lesions (9.5%). The 6- and 12-month cumulative incidences of local failure were 4.8% and 6%, respectively. Seven patients developed radiation-related neuropathy, and 1 patient developed myelopathy. The vertebral compression fracture rate was 16.7%. CONCLUSION: In patients with extensive disease involvement, reSBRT of spine metastases with 40 Gy in 5 fractions seems to be safe and effective. Prospective trials are needed to determine the optimal dose and fractionation in this clinical scenario.
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Radiocirugia , Reirradiación , Terapia Recuperativa , Neoplasias de la Columna Vertebral , Humanos , Radiocirugia/métodos , Masculino , Femenino , Neoplasias de la Columna Vertebral/radioterapia , Neoplasias de la Columna Vertebral/cirugía , Neoplasias de la Columna Vertebral/secundario , Anciano , Persona de Mediana Edad , Estudios Retrospectivos , Reirradiación/métodos , Terapia Recuperativa/métodos , Anciano de 80 o más Años , Adulto , Fraccionamiento de la Dosis de Radiación , Resultado del TratamientoAsunto(s)
Neoplasias de la Mama , Neoplasias de Cabeza y Cuello , Neoplasias Pulmonares , Radiocirugia , Neoplasias del Recto , Humanos , Femenino , Neoplasias Pulmonares/terapia , Neoplasias de la Mama/radioterapia , Terapia Neoadyuvante , Radiocirugia/efectos adversos , Inmunoterapia/efectos adversos , BiologíaAsunto(s)
Radiodermatitis , Radiocirugia , Neoplasias de la Columna Vertebral , Neoplasias del Cuello Uterino , Masculino , Femenino , Humanos , Neoplasias del Cuello Uterino/radioterapia , Neoplasias del Cuello Uterino/cirugía , Próstata , Mastectomía Segmentaria , Neoplasias de la Columna Vertebral/cirugía , Bacterias , Quimioterapia AdyuvanteAsunto(s)
Braquiterapia , Neoplasias Pulmonares , Radioterapia Guiada por Imagen , Carcinoma Pulmonar de Células Pequeñas , Neoplasias del Cuello Uterino , Femenino , Humanos , Braquiterapia/efectos adversos , Neoplasias del Cuello Uterino/diagnóstico por imagen , Neoplasias del Cuello Uterino/radioterapia , Neoplasias del Cuello Uterino/patología , Imagen por Resonancia Magnética , Neoplasias Pulmonares/radioterapia , Dosificación RadioterapéuticaAsunto(s)
Neoplasias de la Mama , Carcinoma Intraductal no Infiltrante , Carcinoma de Células de Merkel , Neoplasias Pulmonares , Neoplasias Nasofaríngeas , Radiocirugia , Sarcoma , Neoplasias Cutáneas , Neoplasias de los Tejidos Blandos , Masculino , Humanos , Neoplasias de la Mama/patología , Carcinoma de Células de Merkel/radioterapia , Próstata/patología , Carcinoma Nasofaríngeo/radioterapia , Neoplasias Pulmonares/patologíaRESUMEN
Importance: Despite federal initiatives encouraging the enrollment of individuals from racial and ethnic minority groups in US clinical trials, no studies to date have specifically examined demographic disparities among participants in phase 1 drug development trials for patients with metastatic cancer. Objective: To assess trends in the enrollment of patients from racial and ethnic minority groups in US phase 1 therapeutic drug trials for metastatic cancer from 2000 to 2018. Design, Setting, and Participants: In this cross-sectional study, ClinicalTrials.gov was queried in July 2021 to identify completed phase 1 drug trials for metastatic cancer in the US from January 1, 2000, to December 31, 2018, with published results, yielding 221 phase 1 trials with 8309 participants aged 18 years or older with metastatic solid tumors. Proportions of each racial and ethnic group of trial participants were compared with that from the North American Association of Central Cancer Registries' Cancer in North America (CiNA) database. Statistical analysis was performed from July 12, 2021, to March 15, 2022. Main Outcomes and Measures: For each racial and ethnic group, the difference between trial and CiNA proportions was examined using a 2-sample test for equality of proportions with continuity correction. Results: The 8309 phase 1 trial participants (4198 men [50.5%]; median age, 59 years) included 23 American Indian or Alaska Native participants (0.3%), 371 Asian or Pacific Islander participants (4.5%), 514 Black participants (6.2%), 401 of 5076 Hispanic or Latinx participants (7.9%), and 7154 White participants (86.1%). Industry funded 165 of the 221 trials (74.7%). White patients were overrepresented overall compared with the corresponding CiNA cohort (7154 of 8309 [86.1%] vs 4â¯113â¯096 of 4â¯891â¯486 [84.1%]; difference, 2.0 percentage points; P < .001). There was an increase in overrepresentation of White patients from 2000 to 2011 (trials, 2780 of 3245 [85.7%]; CiNA, 2â¯378â¯019 of 2â¯800â¯711 [84.9%]; difference, 0.8 percentage points; P = .23) to 2012-2018 (trials, 4374 of 5063 [86.4%]; CiNA, 1â¯735â¯077 of 2â¯090â¯775 [82.9%]; difference, 3.5 percentage points; P < .001) and corresponding worsening representation of American Indian or Alaska Native patients (2000-2011: trials, 10 of 3245 [0.3%]; CiNA, 10â¯905 of 2â¯800â¯711 [0.4%]; difference, -0.08 percentage points; 2012-2018: trials, 13 of 5063 [0.3%]; CiNA, 9484 of 2â¯090â¯775 [0.5%]; difference, -0.20 percentage points), Asian or Pacific Islander patients (2000-2011: trials, 121 of 3245 [3.7%]; CiNA, 75â¯033 of 2â¯800â¯711 [2.7%]; difference, 1.1 percentage points; 2012-2018: trials, 151 of 5063 [3.0%]; CiNA 70â¯535 of 2â¯090â¯775 [3.4%]; difference, -0.75 percentage points), Black patients (2000-2011: trials, 244 of 3245 [7.5%]; CiNA, 322â¯701 of 2â¯800â¯711 [11.5%]; difference, -4.0 percentage points; 2012-2018: trials, 270 of 5063 [5.3%]; CiNA, 255â¯625 of 2â¯090â¯775 [12.2%]; difference, -6.9 percentage points), and Hispanic or Latinx patients (2000-2011: trials, 161 of 1792 [9.0%]; CiNA, 169â¯297 of 2â¯800â¯711 [6.0%]; difference, 3.0 percentage points; 2012-2018: trials, 240 of 3295 [7.3%]; CiNA, 156â¯118 of 2â¯090â¯775 [7.5%]; difference, -0.2 percentage points). Similar disparities were observed when comparing industry-funded and academic center-sponsored trials. Conclusions and Relevance: In this cross-sectional study of participants in phase 1 clinical trials of drugs for metastatic cancer, worsening disparities were observed over time in the accrual of patients from racial and ethnic minority groups. These findings may represent widening inequalities in access to trial sites and worsening systemic biases. More efforts are needed to diversify phase 1 cancer drug trials to improve equity in access to new treatments and to ensure that safety and efficacy findings from early drug trials are generalizable across populations.
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Antineoplásicos , Neoplasias , Masculino , Humanos , Persona de Mediana Edad , Etnicidad , Grupos Minoritarios , Estudios Transversales , Minorías Étnicas y Raciales , Neoplasias/tratamiento farmacológico , Desarrollo de MedicamentosAsunto(s)
Irradiación Craneoespinal , Neoplasias de la Próstata , Antagonistas de Andrógenos/farmacología , Antagonistas de Andrógenos/uso terapéutico , Andrógenos , Humanos , Ganglios Linfáticos/patología , Masculino , Terapia Neoadyuvante , Recurrencia Local de Neoplasia , Posición Prona , Próstata/patología , Antígeno Prostático Específico , Neoplasias de la Próstata/tratamiento farmacológico , Neoplasias de la Próstata/radioterapia , Terapia RecuperativaAsunto(s)
Neoplasias Nasofaríngeas , Neoplasias de la Próstata , Neoplasias del Recto , Protocolos de Quimioterapia Combinada Antineoplásica , Quimioradioterapia/métodos , Cisplatino/uso terapéutico , Detección Precoz del Cáncer , Humanos , Imagen por Resonancia Magnética , Masculino , Carcinoma Nasofaríngeo/terapia , Neoplasias Nasofaríngeas/diagnóstico por imagen , Neoplasias Nasofaríngeas/terapia , Terapia Neoadyuvante , Estadificación de Neoplasias , Neoplasias de la Próstata/diagnóstico por imagen , Neoplasias de la Próstata/tratamiento farmacológico , Neoplasias del Recto/patologíaAsunto(s)
Neoplasias de la Mama , Neoplasias Pulmonares , Neoplasias Pancreáticas , Neoplasias de la Próstata , Androstenos , Receptores ErbB/genética , Humanos , Neoplasias Pulmonares/genética , Neoplasias Pulmonares/patología , Neoplasias Pulmonares/terapia , Masculino , Terapia Neoadyuvante , Neoplasias Pancreáticas/terapia , Neoplasias de la Próstata/genética , Neoplasias de la Próstata/terapia , Neoplasias PancreáticasRESUMEN
PURPOSE: Our purpose was to evaluate the effect of the current structure and schedule of the American Board of Radiology (ABR) radiation oncology initial certification (RO-IC) examinations, with a primary focus on implications for family planning and early professional barriers among female radiation oncologists. METHODS AND MATERIALS: A survey was conducted of crowdsourced ABR candidates and diplomates for radiation oncology between June and July of 2020. The primary study cohort was early career female radiation oncologists of the 2016 through 2021 graduating classes. RESULTS: The survey response rate of early career female radiation oncologists was 37% (126 of an estimated 337). Among this cohort, 58% (73 of 126) reported they delayed or are currently delaying/timing pregnancy or adoption to accommodate the annual schedule of the 4 qualifying and certifying examinations required to achieve board certification in radiation oncology. One in every 3 respondents who had attempted to become pregnant reported experiencing infertility (25 of 79, 32%). Women who reported intentionally delaying pregnancy to accommodate the ABR RO-IC examination schedule were significantly more likely to experience infertility (46% vs 18%, P = .008). Seven women (6%) reported at least a 1-year delay in sitting for a RO-IC examination due to an unavoidable scheduling conflict related to childbirth and/or the peripartum period. A majority reported that full board certification had a significant effect on achieving academic promotion or professional partnership (52%), annual compensation (54%), and nonclinical professional commitments (58%) - these rates mirror those of surveyed early career male counterparts (n = 101). CONCLUSIONS: The current structure and scheduling of the ABR RO-IC examinations imposes noteworthy hurdles for many female radiation oncologists when entering the workforce. The recent transition to virtual examination platforms creates an important opportunity to increase flexibility in the structure and scheduling of the board examination process to improve equitable board certification practices.