Adenocarcinomas of the esophagus and gastric cardia: medical conditions, tobacco, alcohol, and socioeconomic factors.

Adenocarcinomas of the esophagus and gastric cardia have increased in incidence over the past 10-15 years in Western countries. The cause for this increase in incidence is still unknown. Our study was designed to investigate potential risk factors for adenocarcinomas of the esophagus and gastric cardia and to compare the risk profiles of a group of patients with this cancer with those having distal stomach cancer. We studied 95 incident cases with the pathological diagnosis of adenocarcinomas of the esophagus and gastric cardia, 67 patients with adenocarcinomas of the distal stomach, and 132 cancerfree controls. Patients were seen at Memorial Sloan-Kettering Cancer Center from November 1, 1992 to November 1, 1994. Epidemiological data were collected by a modified National Cancer Institute Health Habits History Questionnaire. Risk factors were analyzed using Mantel-Haenszel methods and a logistic regression model. Hypertension was associated with a 2-fold increased risk of adenocarcinomas of esophagus and gastric cardia after controlling for age, sex, race, education, pack-years of smoking, alcohol use, body mass index, and total dietary intake of calories. Increased risk of adenocarcinomas of esophagus and gastric cardia was associated with age, male gender, and Caucasian race. Tobacco smoking was related to a modest risk of adenocarcinomas of esophagus and gastric cardia. In contrast, the risk of distal stomach cancer was associated with stomach ulcers and pack-years of cigarette smoking. Iron deficiency was significantly associated with increased risk of both adenocarcinomas of the esophagus and gastric cardia and adenocarcinomas of the distal stomach. No obvious associations were identified for occupational exposures, family history of cancer, and physical activities. This study suggests that medical conditions such as hypertension and iron deficiency may be related to the risk of adenocarcinomas of esophagus and gastric cardia and confirms the moderate risk associated with tobacco smoking. Our results indicated an etiological heterogeneity with respect to risk factors identified between adenocarcinomas of esophagus and gastric cardia and those of the distal stomach.

Patient satisfaction with an informed consent process.

PURPOSE: This study evaluates patient and family member level of satisfaction with alternative approaches in obtaining informed consent before colonoscopy or upper gastrointestinal endoscopy. DESCRIPTION: A convenience sample of 204 endoscopy patients at Memorial Sloan-Kettering cancer Center in new York and 102 of their family members were approached to participate in the study. All patients were 19 years of age or older, able to speak and read English, and mentally competent. After proceeding through the informed consent process using both videotape and physician discussion, participants completed a ten-question survey on their previous informed consent experience and their preferences regarding receiving consent information. RESULTS: Overall, participants reported that a combination of videotape and physician explanation was preferred for receiving consent information over either method alone. The participants found that the videotape helped to make the information easier to understand and provided the appropriate amount of information about risks, benefits, and alternatives to the prospective endoscopic procedure. CLINICAL IMPLICATIONS: Patient satisfaction should be a factor in determining the best method of providing informed consent information. Because this study indicates that participants are most satisfied with the method of videotape followed by physician discussion, the addition of the videotape to the informed consent process may be beneficial in preparing the participant for a meaningful dialogue with the physician. The use of the videotape also may eliminate the problem of readability of the written document and ensure that all patients receive the same information. With a concerted effort on the part of oncology healthcare providers, including oncologists, nurses, and patient education professionals, this method may hold promise for ensuring the achievement of informed consent in oncology patients.

Adenocarcinomas of the esophagus and gastric cardia: the role of diet.

The incidence of adenocarcinomas of the esophagus and gastric cardia (ACEGC) has been increasing for the past 10-15 years in the United States. The reason for this increase is unknown. This hospital-based case-control study was conducted to assess the effects of dietary and nutritional factors on the risk of ACECG. A total of 95 incident cases with pathological diagnosis and 132 cancer-free controls were included in the study. Patients were recruited at Memorial Sloan-Kettering Cancer Center from 1 November 1992 to 1 November 1994. Epidemiologic data were collected by a modified National Cancer Institute Health Habits History Questionnaire. Nutritional and dietary factors were analyzed using a logistic regression model. Increased risk of ACEGC was significantly related to higher intake of dietary calories and fat after controlling for several potential confounding factors. Decreased risk of ACEGC was significantly associated with high ingestion of dietary fiber, lutein, niacin, vitamin B6, iron, and zinc. Higher intakes of vitamin A, beta-carotene, vitamin E, folate, phosphorus, and potassium were associated with a decreased risk of the disease, but these were not statistically significant. The study suggests that ACEGC can be preventable through dietary interventions.