Long-Term Quality of Life After Esophagectomy for Esophageal Cancer.

BACKGROUND: Surgery, as part of a multimodal approach, offers the greatest chance of cure for esophageal cancer. However, esophagectomy is often perceived as having a lasting impact on quality of life (QOL), biasing some physicians and patients toward nonoperative management. A comprehensive understanding of the dynamic changes in patient-centered outcomes is therefore important for decision making. Our objective was to determine the long-term QOL after esophagectomy. METHODS: Data were obtained from a prospectively collected (2006-2015) esophagectomy database at a high-volume center, and patients surviving 3 or more years were identified. Health-related QOL was evaluated using the Functional Assessment of Cancer Therapy-Esophageal Module (FACT-E) at diagnosis and every 3 to 6 months, and was stratified according to operative approach, stage, and complications. In addition, QOL scores were compared with normative population values. RESULTS: Of 480 patients, 47% (n = 226) survived 3 or more years and 70% (158 of 226) completed the health-related QOL assessments. Time of follow-up was 5.1 ± 2.8 years. After a reduction at 1 to 3 months, FACT-E increased from a baseline of 126 (95% CI, 121-131) to 133 (95% CI, 127-139) at 12 months, and to 147 (95% CI, 142-153) by 5 years. There was no difference in long-term FACT-E with respect to the surgical approach, clinical and pathologic stage, or postoperative complications. At long-term follow-up (more than 3 years), QOL did not differ significantly from the normative population reference values. CONCLUSIONS: The long-term QOL of esophagectomy patients surviving at least 3 years is improved when compared with the time of diagnosis and does not differ from the general population.

Regulatory T Cells in Angiogenesis.

Regulatory T cells (Tregs) are crucial mediators of immune homeostasis. They regulate immune response by suppressing inflammation and promoting self-tolerance. In addition to their immunoregulatory role, a growing body of evidence highlights the dynamic role of Tregs in angiogenesis, the process of forming new blood vessels. Although angiogenesis is critically important for normal tissue regeneration, it is also a hallmark of pathological processes, including malignancy and chronic inflammation. Interestingly, the role of Tregs in angiogenesis has been shown to be highly tissue- and context-specific and as a result can yield either pro- or antiangiogenic effects. For these reasons, there is considerable interest in determining the molecular underpinnings of Treg-mediated modulation of angiogenesis in different disease states. The present review summarizes the role of Tregs in angiogenesis and mechanisms by which Tregs regulate angiogenesis and discusses how these mechanisms differ in homeostatic and pathological settings.

Cyanoacrylate Tissue Adhesive for the Treatment of Corneal Thinning and Perforations: A Multicenter Study.

PURPOSE: To examine the outcomes of cyanoacrylate tissue adhesive (CTA) application for impending or frank corneal perforations and assess for predictors of treatment response. METHODS: A multicenter cohort study was conducted to assess the clinical outcomes of adult patients who underwent CTA gluing for impending or frank corneal perforations between 2013 and 2018. The primary outcome was the proportion of successful CTA applications, defined as tectonic stability of the globe without subsequent keratoplasty (KP). Secondary outcomes included visual acuity and success of subsequent surgical interventions, if performed. RESULTS: Fifty-three eyes of 52 patients were included in this study [56% women; mean age at presentation 70 ± 13 years; median length of follow-up of 387 days (interquartile range: 191-704)]. Medical comorbidities were present in 62% of patients. The most common etiologies for perforations included infections (43%) and Sjogren disease (9%). Of the CTA-treated eyes, 22% had a complete resolution of the corneal lesion. Fifty-four percent of patients underwent KP. Longer duration of CTA treatment was associated with CTA success (P = 0.04). For patients requiring KP, 71% were successful and 29% failed. There is no significant difference in the median time delay between patients with successful and failed KPs (P = 0.4). CONCLUSIONS: CTA may be considered a stand-alone treatment for corneal perforations. It yielded a success rate of 22%. Failed CTA treatment occurred quickly, largely because of the severity of presentation. In cases requiring KP, the delay between glue application and surgery did not influence the PK success.

Quality of life considerations in uveal melanoma patients: a systematic review.

OBJECTIVE: The aim of this study is to examine the quality of life (QOL) outcomes of patients undergoing different uveal melanoma (UM) treatments and to appraise the literature on the topic. DESIGN AND PARTICIPANTS: A systematic review was conducted to address the study objective. Patients undergoing UM treatment with or without metastasis were eligible for inclusion in this review. METHODS: A literature search was performed using National Library of Medicine (PubMed), Embase, Ovid online, and Cochrane Central Register of Controlled Trials databases. We included all English, original retrospective or prospective studies published between January 1998 to September 2019 in which the primary outcome was the QOL of patients with treated UM. RESULTS: Our search strategy yielded 101 articles. Of these, 18 articles met all our inclusion criteria. The majority of included articles (61%) are cross-sectional studies. On average, each study employed 2 different QOL assessment tools. Overall, physical functioning and mental well-being are impaired in patients with UM after treatment compared with the general population. The severity of the impairment decreases as early as 3 months post-treatment; 8 of 12 studies comparing treatment options reported no statistical difference in physical functioning between treatments; 4 of 12 studies reported better visual function with radiation therapy compared with enucleation, 2 of which described no difference between the 2 options at long-term. Anxiety is more prevalent than depression, and both decrease to less than 10% at 1-year follow-up. CONCLUSIONS: Overall, there is no significant difference in long-term QOL in patients with UM from different treatment groups past 1-year follow-up. This work underscores the need for and importance of developing a standardized, complete assessment tool tailored to the challenges inherent to the diagnosis of UM.

Barriers in Access to Care for Patients With Head and Neck Cancer in Resource-Limited Settings: A Systematic Review.

Importance: The identification of the barriers to care for patients with head and neck cancer in low-income and lower-middle-income countries is a crucial first step toward the identification of targets for developing and implementing cost-effective programs to increase awareness, prevention, and treatment of head and neck cancer in this setting. Objective: To identify the barriers to care for patients presenting with head and neck cancer in low-income and lower-middle-income countries. Evidence Review: Nine databases were searched from their inception to December 21, 2017: Africa-Wide Information, the Cochrane Library, Embase, Global Health, LILACS, MEDLINE, BIOSIS Previews, and Web of Science. Search terms referred to head and neck cancer, barriers to care, and low- and lower-middle-income countries, and no temporal and linguistic restrictions were imposed. Articles were reviewed by 2 independent investigators, and differences in inclusion were resolved by discussion. Bibliographies of all included articles were screened, and all relevant articles were reviewed using the same procedure. Quantitative articles were assessed using the Methodological Index for Non-Randomized Studies tool, and articles with qualitative data used the Critical Appraisal Skills Programme qualitative checklist. This systematic review was registered in PROSPERO (registration No. CRD42018092448) and followed the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. Findings: Of the 44 articles selected for review, 18 (41%) met the selection criteria. All articles reported quantitative results, and 3 (17%) added some qualitative material to the study design. Most (11 [61%]) of the studies originated from India. A total of 41 different barriers to care were identified, with low level of education (cited in 8 articles [44%]), low socioeconomic status (in 4 articles [22%]), and lack of knowledge about head and neck cancer (in 3 articles [17%]) being statistically associated with a delayed presentation. Misunderstanding of signs and symptoms, use of alternative medicine, and inability to access health care were other barriers discussed in the qualitative articles. Conclusions and Relevance: This systematic review highlighted the lack of both qualitative and quantitative information for patients with head and neck cancer in low-income and lower-middle-income countries. The findings suggest that integrating the barriers to care with information from patient lives may identify the clinical and social relevance of these barriers and guide future research.